Job Summary
A health care provider has an open position for a Remote Quality Assurance Analyst in Pittsburgh.
Core Responsibilities of this position include:
- Maintaining employee/insured confidentiality
- Understanding customers including internal Health Plan Departments (i.e. claims staff, customer service, Marketing, etc.) and external customers (i.e. Health System Internal Audit, Client Audit teams) and respond to customers' requests
- Working with Reimbursement and Configuration Specialists to ensure correct payments and identify/resolve payment inaccuracies
Qualifications for this position include:
- High school and four (4) years of claims processing, experience in physician, ancillary and/or hospital reimbursement delivery systems or insurance reimbursement, including subrogation and overpayment recovery or a Bachelor's degree
- Basic understanding of managed care delivery systems
- Experience and knowledge of reimbursement mechanisms and clinical/procedural coding or five years of claims processing experience
- Excellent analytical skills, familiarity with basic statistical analysis, and proficiency in utilizing PC based applications (i.e. Excel, MS access, COGNOS)
