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Quality Analyst I

  • Job ID: 888003521
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Provider Reimbursement
  • Location: 339 Sixth Avenue, Pittsburgh PA 15222
  • Union Position: No
  • Salary Range: $17.39 to $27.61 / hour

Description

Are you detail-oriented? Do you have a background in claims processing or quality management with claims? Whether you're looking for a collaborative team setting, a career path that can lead to leadership, an excellent work-life balance, or experience with an industry leader, our Quality Analyst I opportunity offers many ways for you to get involved!

UPMC is hiring a full-time Quality Analyst I to support the Provider Reimbursement department within the Community Care Behavioral Health business unit. The Quality Analyst I is a Monday - Friday, daylight role. Due to COVID-19 circumstances, this will be a hybrid role, with some remote work and some travel into the office.

The Quality Analyst I will work directly with the Associate Operations Analyst to monitor the quality and timeliness of claims processes. Monitoring with be accomplished by utilizing in-house and system generated reports, as well as the findings from the in-house claims audits. The Claims- Quality Analyst I will work to identify quality, as well process improvement. The Quality Analyst I is responsible to communicate outcomes, directly to the Associate Operations Analyst.


Responsibilities:

  • Assure the Community Care claims staff meet and exceed the processing/audit standards
  • Analyze management reports regarding performance of any/all Claims processes
  • Assure the TPA meets and exceeds the Claims processing and audit standards
  • ACCOUNTABILITIES: Level of service provided; maintain ongoing communications with Claims Director and Claim Manager, Claims Supervisor; Initiative in pursuing issues; assumption of responsibilities. Application of analyses.
  • Identify any/all claims/audit process issues through report analysis.

Qualifications

  • 2 years experience in Claims Processing and/or Quality section of the claims processing department.
  • Working knowledge of all managed care functions related to Quality Assurance.
  • Excellent communication and interpersonal skills.
  • Ability to problem solve independently.


Licensure, Certifications, and Clearances:

 


UPMC is an Equal Opportunity Employer/Disability/Veteran

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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