Insight Analyst

Change Healthcare
Published
July 14, 2019
Location
Lombard, IL
Job Type

Description

Transforming the future of healthcare isn’t something we take lightly. It takes teams of the best and the brightest, working together to make an impact. As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities. Here at Change Healthcare, we’re using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.

If you’re ready to embrace your passion and do what you love with a company that’s committed to supporting your future, then you belong at Change Healthcare. Pursue purpose. Champion innovation. Earn trust. Be agile. Include all. Empower Your Future. Make a Difference.
The Insight Analyst will be 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 cases are handled appropriately and resolved in a timely manner.

Responsibilities Of Position

  • Properly manage daily workload to ensure that established task turn-around-times (TATs) are met
  • Write Insight Summary Reports detailing case findings and recommendations
  • 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 record review scenarios
  • Identify and recommend positive enhancements to systems and processes
  • Identify and request reports from the data analytics team
  • Actively promotes 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

Qualifications

  • BA/BS degree in law enforcement, criminal justice, criminology or related field required. 2+ years of fraud, waste and abuse experience may be substituted for each year of academic study
  • Minimum 3 years of experience in healthcare related or healthcare claims industry
  • Experience with government healthcare programs preferred (Medicare, Medicaid)
  • Strong communication and customer service skills
  • Self-starter with superior oral and written communications skills
  • Ability to work independently but also as a member of a team
  • Strong time management, problem solving, organizational, and analytical skills required
  • Must be proficient in Microsoft Office applications
  • Must be detail oriented and possess the ability to multi-task

Healthcare Fraud Designation Required. CFE Or AHFI Certifications Preferred

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

Equal Opportunity/Affirmative Action Commitment

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Company Description

Change Healthcare is inspiring a better healthcare system. Change Healthcare is a key catalyst of a value-based healthcare system – working alongside our customers and partners to accelerate the journey toward improved lives and healthier communities.

While the point of care delivery is the most visible measure of quality and value, we are a healthcare technology solutions company that uniquely champions the improvement of all the points before, after, and in-between care episodes. With our customers and partners, we are creating a stronger, better coordinated, increasingly collaborative, and more efficient healthcare system that enables better patient care, choice, and outcomes at scale.

Through our unique perspective and interconnected position at the center of healthcare, we are a collaborative catalyst to accelerating your path to value-based care and more relevant engagement with consumers. We are an inseparable part of today’s healthcare ecosystem - playing a vital role in helping the system not only function, but also work smarter. Our engrained technology solutions and connected insights reflect our unique knowledge of the system’s many intricacies and the critical paths to better healthcare.

We know we are entrusted with the most sensitive information and systems. We are dedicated to providing the highest levels of quality, security, and solutions. We believe trust is earned with every interaction, with every customer, and at every opportunity to deliver healthcare safely and effectively.

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