Internal Auditor, Intermediate

Company: UPMC Location: Pittsburgh, PA 15123 Status: Full Time, Employee Job Category: Accounting/Finance/Insurance Career Level: Experienced (Non-Manager) Company: UPMC Reference Code: 1039713UPMC is an integrated global health enterprise headquartered in Pittsburgh, Pennsylvania, and one of the leading non-profit health systems in the United States. As western Pennsylvania’s largest employer, with 48,000 employees and nearly $7 billion in revenue, UPMC is transforming the economy of the region into one based on medicine, research, and technology. By integrating 20 hospitals, 400 doctors’ offices and outpatient sites, long-term care facilities, and a major insurance plan, UPMC has advanced the quality and efficiency of health care and developed internationally renowned programs in transplantation, cancer, neurosurgery, psychiatry, orthopedics, and sports medicine, among others. UPMC is commercializing its medical and technological expertise by nurturing new companies, developing strategic business relationships with some of the world’s leading multi-national corporations, and expanding into international markets; including Italy, Ireland, the United Kingdom, and Qatar. For more information about UPMC, visit our website at www.upmc.com. Internal Auditor, Intermediate Job SummaryThe UPMC Health Plan is currently seeking an internal auditor - intermediate to help support the Quality Audit department located in downtown Pittsburgh.  This position will work Monday through Friday, and hours between 8:00a.m. to 5:00p.m.  The internal auditor - intermediate is responsible for quality review and or internal audit of processed claims, checks, adjustments, membership applications, work flows, policies/procedures, regulatory requirements of the UPMC Health Plan.Job Responsibilities- Performs quality review on all types of claims, adjustments and related health insurance documentation using root cause analysis in accordance with company policies and procedures. - Interfaces with internal and external customers to meet or exceed service requirements and requests. - Represents QA department at internal and external Health Plan meetings. - Performs higher level auditing functions such as focused audits and comparative analysis. - Provides trending, analysis and reporting of auditing data. - Performs other duties as necessary.Basic Qualifications- Bachelor's degree in job related fields or equivalent education/experience is required. - Eight years of claims processing  and/or general auditing experience is required. - In-depth knowledge of medical terminology, ICD-9 and CPT-4 coding is required. - Advanced proficiency in Word, Access, Excel, Power point and Visio is required.Licenses/Certifications - CIA certification is preferred. - Certified Professional Coder is preferredUPMC offers a variety of benefit options designed to provide personal security, convenience, and assistance to you and your family. With this flexibility and choice, you can decide which options best meet your needs. Apply at www.upmc.com by following these steps; click Careers at UPMC, Start My Job Search, and follow the link to continue to search and apply for openings. Select Advanced Search and enter 1039713 in the job opening ID field.  UPMC is an equal opportunity employer.