At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic unfolds. Visit upmc.com/vaccinesupport to learn more about how you can help.

Our recruiters will continue to fill positions throughout this time, but interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Quality Assurance Excellence Analyst, Intermediate

Description

Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. From hospitals to our corporate office, all UPMC employees impact our mission of creating life changing medicine. To continue our tradition of excellence, we are in search for a Quality Assurance Excellence Analyst, Intermediate to join this community as well.

Do you have excellent documentation, organization, interpersonal, and written communication skills as well as experience in insurance claims and MC400? If so, this role is for you! Under the leadership of the Sr. Manager of Quality Assurance, the QA Excellence Analyst Intermediate will perform comprehensive analysis of data and information for various Health Plan products, evaluation of clients business environments and works with client professionals to develop requirements for solutions related to business operations.

Responsibilities:

  • Participates in higher level auditing activities such as focused audits of operational, regulatory and other controls.
  • Works with management on all QA initiatives such as meaningful use of the QA auditors guidelines. Manages changes by working closely with the client, vendors, and team. Protects the integrity and confidentiality of all data and information through physical and electronic measures
  • Provide service according to the expectations of policies/procedures and standards developed around the QA review process for client departments. Evaluates and documents client needs and all aspects of business processes both operational and financial, including current process analysis; and proposed revisions to optimize business processes.
  • Designs and maintains reports, auditing tools, databases and related documentation.
  • Serve as a QA Department representative at internal and external meetings, document and present findings to QA Staff.
  • Assists in the development and revision of QA department policies and procedures.
  • Identifies root causes and associated error trends to determine appropriate training needs and suggest modifications to policies and procedures.
  • Works with Reimbursement and Configuration Specialists to ensure correct payments and identify/resolve payment inaccuracies.
  • Participates in all training programs to develop a thorough understanding of the materials presented to the claim and service staff.
  • Devises sampling methodology and retrieves audit samples from appropriate sources.
  • Leads process improvement activities, target potential problems.
  • Understands 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.
  • Assesses, investigates and resolves difficult issues to ensure customer satisfaction.
  • Compiles and reports statistical data to internal and external customers.

 

Qualifications

  • Bachelor's Degree and/or equivalent education or work experience
  • Five (5) years operations health insurance, business and/or customer service experience required.
  • Claims experience and MC400 experience are strong preferences
  • Excellent documentation, organization, interpersonal, and written communication skills.
  • Strong analytical skills and auditing skills Advanced analytical/problem solving and research skills with proven ability to make data driven decisions;
  • Proficient in Excel and PowerPoint
  • Working knowledge of relational databases, database structures
  • Ability to operate independently: exhibiting independent decision making in a fast paced environment dealing with a high level of ambiguity.
  • Strong time management skills.
  • Excellent documentation, organization, interpersonal, and written communication skills.
  • A professional demeanor with the ability to manage multiple priorities and meet deadlines required.
  • Comprehensive report generation/claim data extraction Strong time management skills.
  • Excellent documentation, organization, interpersonal, and written communication skills.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct