Insight Analyst - Remote (Anywhere US)

Change Healthcare

Florida

United States

Customer Service / Call Center
(No Timezone Provided)

The Insight Analyst is responsible for reviewing healthcare claims for possible fraud, waste and abuse. Actively work to identify and prevent payment of inappropriate or erroneous charges submitted by healthcare providers. Required to manage workload to ensure that claims are handled appropriately and resolved in a timely manner.

What will be my duties and responsibilities in this job?

  • Properly manage daily workload to ensure that established task turn-around-times (TATs) are met 

  • Adhere to multiple client directives and customizations to properly determine the handling of the claims

  • Effectively communicate with clients, account managers, Insight Analysts, and Insight Analyst Assistants

  • Thoroughly review medical records/documentation and claim history to identify aberrant patterns or trends and exercise independent decision making to determine appropriate follow-up

  • Use the appropriate resources (state or board websites) to verify provider licensure and check for sanctions

  • Work closely with the Insight Analyst Assistants to manage workload and provide direction

  • Attend anti-fraud or healthcare related seminars, audio conferences and webinars throughout the year for the purposes of continuing education and training

  • Acquire/maintain proficiency on all aspects of healthcare Fraud, Waste and Abuse

  • Conduct research on providers using the internet and other resources for case development

  • Recommend algorithms and code edits for edits for record review scenarios

  • Recommend algorithms and enhancements to artificial intelligence models used to identify claims for review

  • Identify and recommend positive enhancements to systems and processes

  • Identify and request reports from the data analytics team

  • Actively promote a team environment

  • Exercise independent decision making

  • Perform thorough documentation of all phone calls, conversations and actions taken on each medical record review

  • Understand and adhere to HIPAA privacy requirements

  • What are the requirements needed for this position?

  • 2+ years of fraud, waste and abuse experience or healthcare claims processing experience

  • What critical skills are needed for you to consider someone for this position?

  • Knowledge of correct coding rules

  • Knowledge of basic schemes in fraud, waste, and abuse and how to identify them

  • Self-starter with superior oral and written communications skills

  • Ability to work independently but also as a member of a team

  • Strong analytical and problem solving skills required

  • Must be detailed and organized

  • Must be proficient in Microsoft Office with strong general computer skills

  • Excellent time management skills with ability to manage multiple, concurrent projects, priorities, tasks, effectively

  • Experience working with customers or clients

  • What other skills/experience would be helpful to have?

  • EDUCATION: BA/BS degree or equivalent experience

  • Experience with government healthcare programs preferred (Medicare, Medicaid)

  • Healthcare fraud designation highly desirable. CFE or AHFI certifications preferred

  • What are the working conditions and physical requirements of this job?

  • General office demands/Home office

  • How much should I expect to travel?

  • No travel

  • Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

    Insight Analyst - Remote (Anywhere US)

    Change Healthcare

    Florida

    United States

    Customer Service / Call Center

    (No Timezone Provided)

    The Insight Analyst is responsible for reviewing healthcare claims for possible fraud, waste and abuse. Actively work to identify and prevent payment of inappropriate or erroneous charges submitted by healthcare providers. Required to manage workload to ensure that claims are handled appropriately and resolved in a timely manner.

    What will be my duties and responsibilities in this job?

  • Properly manage daily workload to ensure that established task turn-around-times (TATs) are met 

  • Adhere to multiple client directives and customizations to properly determine the handling of the claims

  • Effectively communicate with clients, account managers, Insight Analysts, and Insight Analyst Assistants

  • Thoroughly review medical records/documentation and claim history to identify aberrant patterns or trends and exercise independent decision making to determine appropriate follow-up

  • Use the appropriate resources (state or board websites) to verify provider licensure and check for sanctions

  • Work closely with the Insight Analyst Assistants to manage workload and provide direction

  • Attend anti-fraud or healthcare related seminars, audio conferences and webinars throughout the year for the purposes of continuing education and training

  • Acquire/maintain proficiency on all aspects of healthcare Fraud, Waste and Abuse

  • Conduct research on providers using the internet and other resources for case development

  • Recommend algorithms and code edits for edits for record review scenarios

  • Recommend algorithms and enhancements to artificial intelligence models used to identify claims for review

  • Identify and recommend positive enhancements to systems and processes

  • Identify and request reports from the data analytics team

  • Actively promote a team environment

  • Exercise independent decision making

  • Perform thorough documentation of all phone calls, conversations and actions taken on each medical record review

  • Understand and adhere to HIPAA privacy requirements

  • What are the requirements needed for this position?

  • 2+ years of fraud, waste and abuse experience or healthcare claims processing experience

  • What critical skills are needed for you to consider someone for this position?

  • Knowledge of correct coding rules

  • Knowledge of basic schemes in fraud, waste, and abuse and how to identify them

  • Self-starter with superior oral and written communications skills

  • Ability to work independently but also as a member of a team

  • Strong analytical and problem solving skills required

  • Must be detailed and organized

  • Must be proficient in Microsoft Office with strong general computer skills

  • Excellent time management skills with ability to manage multiple, concurrent projects, priorities, tasks, effectively

  • Experience working with customers or clients

  • What other skills/experience would be helpful to have?

  • EDUCATION: BA/BS degree or equivalent experience

  • Experience with government healthcare programs preferred (Medicare, Medicaid)

  • Healthcare fraud designation highly desirable. CFE or AHFI certifications preferred

  • What are the working conditions and physical requirements of this job?

  • General office demands/Home office

  • How much should I expect to travel?

  • No travel

  • Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!