Location
Pittsburgh, PA, United States
Posted
June 29, 2026
Job Description
UPMC Health Plan has an exciting opportunity for a Clinical Appeals Coordinator position in the Provider Disputes CGA department. This is a full-time hybrid position working Monday through Friday daylight hours, with occasional on call shifts. This position is based in the Pittsburgh area. While you'll primarily work remotely, you'll come into the office occasionally depending on departmental needs.
This position coordinates and completes all medically necessary provider appeals. The functions include reviewing cases for medical necessity, coordination with the Medical Directors and preparing regulatory submission packets based on medical necessity to CMS for Medicare provider appeals. The provider clinical review is for all levels of services and all lines of business.
Responsibilities:
+ Review, investigate and complete appeals related to medical necessity, appropriate level of service and benefit coverage for all lines of business in required timeframes.
This position coordinates and completes all medically necessary provider appeals. The functions include reviewing cases for medical necessity, coordination with the Medical Directors and preparing regulatory submission packets based on medical necessity to CMS for Medicare provider appeals. The provider clinical review is for all levels of services and all lines of business.
Responsibilities:
+ Review, investigate and complete appeals related to medical necessity, appropriate level of service and benefit coverage for all lines of business in required timeframes.