Location: Pittsburgh, PA
Cap-Exempt H-1B Position — No lottery required
Are you passionate about ensuring accuracy and driving efficiency in healthcare reimbursement? At UPMC Health Plan, we’re looking for a Senior Payment Accuracy Analyst to play a critical role in shaping how claims are processed and paid. This is your opportunity to make a real impact on payment integrity and compliance while collaborating with talented teams across the organization. **What You’ll Do:** In this role, you’ll be the go-to expert for payment accuracy and claim editing. You’ll work closely with our external software vendor and internal teams to implement and maintain industry-standard clinical coding edits. Your insights will help us ensure compliance with Medicare, Medicaid, and other payor requirements while identifying opportunities for cost savings. Here’s what your day-to-day will look like: - Turn data into decisions: Use your expertise in SQL and BI tools like Power BI and Tableau to create dashboards and actionable insights - Collaborate across teams: Partner with Claims Operations, Medical Policy, IT, and more to align edits with clinical and financial goals. - Lead impactful projects: Drive initiatives that monitor and adapt to changes in payment and medical policy. - Be the subject matter expert: Advise leadership on coding and policy changes, ensuring edits work as intended and meet compliance standards. - Stay ahead of the curve: Keep up with industry trends, regulatory updates, and evolving payment models. **What We’re Looking For:** - Strong skills in data reporting and visualization (SQL, Power BI, Tableau). - Deep knowledge of coding standards and claim editing (AMA, CMS, NCCI). - Ability to analyze complex data, identify root causes, and recommend solutions. - Excellent communication skills to work with leadership and cross-functional teams. A proactive mindset to lead projects and drive continuous improvement. **This position is hybrid. There is an in-office requirement of at least once per month. Additional time in the office may be r