Insight Analyst Triager – Change Healthcare – Wyoming

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?

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?

How much should I expect to 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.

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