Hybrid QA Analyst, Intermediate - Claims & Audit Improvement

Pittsburgh Tomorrow; Pittsburgh (Allegheny County); Híbrido; USD 60.000 - 90.000; Tempo integral

Resumo da vaga

UPMC Health Plan is seeking an Intermediate Quality Analyst in the QAOI department. The position is full-time with a hybrid schedule (work from home and in-office 3 days/week) in Pittsburgh, PA at US Steel Tower.

The Quality Analyst, Intermediate is responsible for the review and reporting of high dollar claims. This auditor also participates in higher level auditing activities such as focused audits of operational, regulatory and other controls.

Qualificações

• High school diploma and 5 years of claims processing experience, or a Bachelor's degree with 1 year of experience.
• Experience in physician, ancillary and/or hospital reimbursement delivery systems or insurance reimbursement.
• Basic understanding of managed care delivery systems.
• Experience and knowledge of reimbursement mechanisms and clinical/procedural coding or five years of claims processing experience, including commercial and government health insurance plans and other insurance/network products.
• Excellent analytical skills, familiarity with basic statistical analysis, and proficiency in PC-based applications (Excel, MS Access, COGNOS).
• Detail-oriented and well-organized with strong communication skills.
• Advanced proficiency with Excel and MS Office products.

Responsabilidades

• Designs and maintains reports, auditing tools, databases and related documentation.
• Maintains employee/insured confidentiality.
• Participates in higher level auditing activities such as focused audits of operational, regulatory or other controls.
• Devises sampling methodology and retrieves audit samples from appropriate sources.
• Assists in the development and revision of QA department policies and procedures.
• Compiles and reports statistical data to internal and external customers.
• Audits high dollar claims on a prospective and/or retrospective basis.
• Leads process improvement activities, target potential problems.
• Understands customers including internal Health Plan Departments and external customers and responds to requests.
• Works with Reimbursement and Configuration Specialists to ensure correct payments and identify/resolve payment inaccuracies.

Conhecimentos

Analytical skills

Statistical analysis

Excel proficiency

MS Access

COGNOS

Communication

Attention to detail

Formação

High school diploma

Bachelor's degree

Ferramentas

Excel

MS Access

COGNOS

ACL

Descrição da vaga

UPMC Health Plan is seeking an Intermediate Quality Analyst in the QAOI department. The position is full-time with a hybrid schedule (work from home and in-office 3 days/week) in Pittsburgh, PA at US Steel Tower.

The Quality Analyst, Intermediate is responsible for the review and reporting of high dollar claims. This auditor also participates in higher level auditing activities such as focused audits of operational, regulatory and other controls.