Allegheny Health Network
Quality Analyst
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Job Description
- Req#: J264661
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $35.18
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to develop and implement process enhancements and internal control improvements
- Work in a role that directly impacts compliance and quality assurance within the company
- Engage in training and development of operational staff
What to Expect (Job Responsibilities):
- Compile and analyze data related to complex adjusted claims and fraud/abuse
- Conduct reviews and audits of organizational activities to ensure compliance with adjustment processes
- Develop management reports detailing findings and trends from audit samples
- Monitor and train quality and operational staff on processes and compliance
- Identify and address potential fraudulent activities in claim processing
What is Required (Qualifications):
- High School Diploma or GED
- 3-5 years of relevant, progressive experience in claims and/or inquiry processing
- Experience with Microsoft Office products
- Strong background in verbal and written communication skills
- Detailed understanding of claims processing arrangements and related performance standards
How to Stand Out (Preferred Qualifications):
- Bachelor’s Degree in a relevant field
- Proficiency with reporting and analytical software tools
- Knowledge of medical terminology and company-related benefits and policies
- Strong problem-solving and analytical skills
- Experience in quality assurance or process improvement methodologies
#HealthcareServices #ClaimsProcessing #QualityAssurance #CareerOpportunity #CompetitivePay
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