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Insight Analyst - Remote (Anywhere US)

R18471 Minneapolis-St. Paul-Bloomington, Minnesota - Additional locations

Additional Locations: Minneapolis-St. Paul-Bloomington, Minnesota, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, Oregon, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Oklahoma, Alabama, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, New Jersey, New Mexico, North Carolina, North Dakota, Ohio Minneapolis, Minnesota, United States of America; VIRTUAL, Pennsylvania, United States of America; VIRTUAL, Rhode Island, United States of America; VIRTUAL, South Carolina, United States of America; VIRTUAL, South Dakota, United States of America; VIRTUAL, Tennessee, United States of America; VIRTUAL, Texas, United States of America; VIRTUAL, Utah, United States of America; VIRTUAL, Vermont, United States of America; VIRTUAL, Virginia, United States of America; VIRTUAL, Washington, United States of America; VIRTUAL, West Virginia, United States of America; VIRTUAL, Wisconsin, United States of America; VIRTUAL, Wyoming, United States of America; VIRTUAL, Massachusetts, United States of America; VIRTUAL, Michigan, United States of America; VIRTUAL, Mississippi, United States of America; VIRTUAL, Missouri, United States of America; VIRTUAL, Montana, United States of America; VIRTUAL, Nebraska, United States of America; VIRTUAL, Nevada, United States of America; VIRTUAL, New Hampshire, United States of America; VIRTUAL, Oregon, United States of America; VIRTUAL, Indiana, United States of America; VIRTUAL, Iowa, United States of America; VIRTUAL, Kansas, United States of America; VIRTUAL, Kentucky, United States of America; VIRTUAL, Louisiana, United States of America; VIRTUAL, Maine, United States of America; VIRTUAL, Maryland, United States of America; VIRTUAL, Oklahoma, United States of America; VIRTUAL, Alabama, United States of America; VIRTUAL, Arizona, United States of America; VIRTUAL, Arkansas, United States of America; VIRTUAL, California, United States of America; VIRTUAL, Connecticut, United States of America; VIRTUAL, Delaware, United States of America; VIRTUAL, Florida, United States of America; VIRTUAL, Georgia, United States of America; VIRTUAL, Hawaii, United States of America; VIRTUAL, Idaho, United States of America; VIRTUAL, Illinois, United States of America; VIRTUAL, New Jersey, United States of America; VIRTUAL, New Mexico, United States of America; VIRTUAL, North Carolina, United States of America; VIRTUAL, North Dakota, United States of America; VIRTUAL, Ohio, United States of America

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.

Insight Analyst

Overview of Position

The Insight Analyst- Triager 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?

  • Perform triage of assigned client claims and make determination on opening cases for medical record review

  • 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

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!

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information,  national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Talent Acquisition Process

Apply

Visit our career site, create a profile, and submit your application. Make sure to observe the job description and see how your background can align to the requirements of the role.

Review

Once you apply for a job opening, the Sourcing Specialist or Talent Adviser will review your resume ensuring your background matches the minimum job requirements. Selected candidates will be invited for a phone screen.

Interviews

Steps will vary by team, but typically include: Talent Advisor phone screen, hiring manager interview, and a combination of technical screens and panel interviews.

Offer

If you're selected, you can expect the Talent Advisor to reach out with specific offer details. During this stage you will be provided with an electronic offer letter and other new hire documents.

Onboarding

Once you've received your offer letter, our onboarding team will get you ready for Week 1 and set you up for success! Onboarding tasks may include a background check, drug screening, and other job specific requirements.

Apply

 

Visit our career site, create a profile, and submit your application. Make sure to observe the job description and see how your background can align to the requirements of the role.

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