Location: all cities,PA, USA
The Quality Specialist has the responsibility of executing analytical skills used for reviewing provider set-up, maintenance, testing and quality checking (QC) various facility reimbursement methodologies. The associate will quality check Facility and Ancillary reimbursement to ensure accuracy within the claim processing system. Tracks all tasks and deliverable dates and maintains all required documentation. Performs data analysis by executing queries and compares using Access. Maintains tracking of the QC for pricing requests within the Consolidated Dashboard. Assist with review and clearing of provider workbaskets. Communicates to management progress on assignments, including time estimates and system schedules. Performs other duties as assigned. Bachelor's Degree in Computer Science, Business or health related field/ commensurate work experience is required 5 years of proven work experience in business unit necessary Aptitude for detail-oriented work. Strong analytical, technical and problem-solving skills. Experience with the following systems: Consolidated Dashboard (CDB) Oscar Claims Web Application (OWCA) Corporate Provider Repository Mainframe System (CPR) TS02 Pricing Files Provider Profiles (HPRCPR) Highmark Mainframe (Oscar) Demonstrate effective communications during work group sessions and meeting. Strong understanding of Facility and Professional Provider data and reimbursement operations required. Advanced understanding of Microsoft Access, Excel, and Word. Demonstrated effective strong oral and written communication skills. The ability to work autonomously with little direction.