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   Current UPMC employees must apply in HR Direct

External Medical Abstraction Operations Analyst, Associate

Description

UPMC Health Plan has an exciting opportunity for an External Operations Analyst, Associate in its Medicare Risk Adjustment department.

While this position is based out of the U.S. Steel Tower in downtown Pittsburgh, the ideal candidate would live in close proximity to his or her assigned area Cambria County and travel from home to the assigned areas on most days.

This position oversees administrative, system processes and special projects as they relate to the identification, implementation and maintenance of the claims transactional system for all UPMC Health Plan products. Under the general direction of Business Support Management, this role will analyze, identify, propose, and implement solutions for all business areas. In addition, he/she will act as a subject matter expert, supporting all areas, and interact with staff to answer questions and resolve issues as they arise. In addition, he/she will be responsible for supporting Risk Adjustment, Quality Improvement, and Organizational Initiatives through onsite and offsite medical record abstraction. The Abstractor will locate, retrieve, and upload appropriate medical records from providers in their assigned area into the collection tool. This position requires active communication and building relationships with contacts in hospitals and practices. The ideal candidate is a highly organized, professional, and self-directed individual.

Responsibilities:

• Model business requirements for new systems, special projects and enhancements to existing systems; validate and test fixes/enhancements to new and existing systems.

• Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction and promote teamwork.

• Performs in accordance with system-wide competencies/behaviors.

• Participates in training programs when available/as requested.

• Effectively prioritize and complete all assigned tasks.

• Assists other departments during periods of backlogs.

• Maintains employee/insured confidentiality.

• Schedule and visit assigned provider locations within designated area

• Develop positive working relationships with providers, nursing, and administrative staff while on-site

• Assist with training new employees through ride-alongs and on the job training sessions

• Abstract health information from patients’ paper or electronic medical charts

• Enter abstracted data into the standard data collection tool

• Update the Provider Information database following each visit

• Assist with administrative tasks and any other tasks assigned

• Performs other job duties as required by manager/supervisor

• Meet deadlines and turnaround times set by department manager and director

• Communicate and collaborate with the Risk Adjustment team

 

Qualifications

  • Bachelor's Degree or equivalent work experience.
  • Minimum two years general business experience.
  • Medical Records Abstraction, Risk Adjustment and/or HEDIS experience is highly preferred
  • Experience in health care insurance or health care industry preferred, but those with relevant experience in other industries will be considered
  • Knowledge of Commercial, Medicaid, Medicare and Individual products preferred.
  • Competence in MS Office required, including MSExcel, MSAccess, MSWord.
  • Excellent planning communication, documentation, analytical and problem solving abilities.
  • Ability to work in a fast-paced environment.
  • Must possess strong interpersonal, organizational, and project management skills, with the ability to work on multiple tasks simultaneously.
  • Experience in QA/Audit/Systems testing development and execution preferred.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct