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   Current UPMC employees must apply in HR Direct

Operations Analyst, Associate

Description

Purpose:
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. Acts as subject matter expert supporting all areas, and interact with staff to answer questions and resolve issues as they arise.

The Operations Analyst, Associate is responsible for supporting the Risk Adjustment Abstraction team. The Internal Medical Abstraction Ops Analyst will assist in the overall operations of the team through abstractor assignments, loading of medical records into the collection tool, reporting, and outreach to provider offices. The ideal candidate is a highly organized, professional, a team player, and analytically oriented.

Responsibilities:

 

  • Identify areas of concern that may compromise client satisfaction through data analysis, and propose solutions based on findings, expertise, and research
  • 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
  • Completes Executive Summary management documentation as required
  • Performs in accordance with system-wide competencies/behaviors
  • Participates in training programs when available/as requested
  • Effectively prioritize and complete all assigned tasks
  • Identify, administer, test, audit, and implement new processes on transactional claims systems
  • Interface with customers by telephone, correspondence, and or in person to answer inquiries and resolve concerns/issues
  • Performs other duties as assigned
  • Assists other departments during periods of backlogs
  • Manages, updates, and maintains source data dictionaries as they relate to processes
  • Completes inquiries generated from the data reporting and analysis area
  • Maintains employee/insured confidentiality
  • Assist with abstraction assignments and roster creation
  • Track abstraction progress to include sites scheduled, sites completed, upload status, etc.
  • Developing and improving reports, metrics, and dashboards
  • Outreach to providers to assist in record collection; Backup external abstractors to pick up records at sites.
  • Scanning, uploading, and QA of data into the record collection        tool.
  • Updating team logbooks for tracking outreach, schedules, issues, etc.
  • Participate in team and department meetings and brainstorming sessions
  • Assisting with updating team processes and procedures.
  • Assists with administrative tasks and any other tasks assigned.
  • Assist with training new hires
  • Meet deadlines and turnaround times set by team Lead and department Manager.
  • Must carry out all responsibilities with minimal direct   supervision

 

Qualifications

  • Bachelor's Degree or equivalent work experience.
  • Minimum two years general business experience.
  • 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

Total Rewards

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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