Job ID: 9851

  • Oct 7, 2020
  • Picadilly Star - Bonifacio Global City

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:

  • Triage assigned client claims and make determinations on opening cases for medical record review
  • 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 edits for record review scenarios
  • 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

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 3-5 years of experience in healthcare related or healthcare claims industry
  • Experience with government healthcare programs preferred (Medicare, Medicaid)
  • Healthcare fraud designation required. CFE or AHFI certifications preferred
  • 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

Skills:

  • 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

MicroSourcing offers diversity in career options. We welcome individuality in self-expression without losing the value for team involvement. We are a fresh look at the BPO & KPO industry. Come experience the MicroSourcing life and be part of our growing family.

Cultures and Values

We are a fast growing company but we have always been able to keep the fun, young and intimate atmosphere from the time we started. We strongly believe in transparency and honesty and we always make sure to represent the interests of our employees as much as we represent the interests of our clients.