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UPMC Health Plan is seeking a full-time Operations Analyst, Associate to support the Medicare HCC Department. This position will be home-based; however, it requires extensive travel throughout the footprint, abstracting medical records physically onsite and in person. The selected candidate must be willing to travel for up to 2 hours. Local candidates to Allegheny and Westmoreland County will be considered.

The Associate Operations Analyst oversees administrative, system processes, and special projects as they relate to the identification, implementation, and maintenance of the claims transactional system for all UPMC Health Plan products. Under the general direction of Business Support Management, this role will analyze, identify, propose, and implement solutions for all business areas. The Associate Operations Analyst acts as a subject matter expert supporting all areas and interacts with staff to answer questions and resolve issues as they arise. The ideal candidate for this position will have previous medical office and/or medical terminology experience, with Electronic Medical Records experience being a plus! Proficient computer and Microsoft Office skills are preferred, as well.

This is a daylight position working Monday through Friday 7:00 a.m. to 3:00 p.m.

Responsibilities:

+ Spend 50% of time physically onsite in offices abstracting medical records via EMR or paper recordIdentify areas of concern that may compromise client satisfaction through data analysis, and propose solutions based on findings, expertise, and research

+ Model business requirements for new systems, special projects and enhancements to existing systems; validate and test fixes/enhancements to new and existing systems

+ Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork

+ Completes Executive Summary management documentation as required

+ Performs in accordance with system-wide competencies/behaviors

+ Participates in training programs when available/as requested

+ Effectively prioritize and complete all assigned tasks

+ Identify, administer, test, audit, and implement new processes on transactional claims systems

+ Interface with customers by telephone, correspondence, and or in person to answer inquiries and resolve concerns/issues

+ Performs other duties as assigned

+ Assists other departments during periods of backlogs

+ Manages, updates, and maintains source data dictionaries as they relate to processes

+ Complete inquiries generated from the data reporting and analysis area

+ Maintains employee/insured confidentiality

+ Bachelor's Degree or equivalent work experience.

+ Minimum two years general business experience.

+ Experience in health care insurance or health care industry preferred, but those with relevant experience in other industries will be considered

+ Knowledge of Commercial, Medicaid, Medicare and Individual products preferred.

+ Competence in MS Office required, including MSExcel, MSAccess, MSWord.

+ Excellent planning communication, documentation, analytical and problem solving abilities.

+ Ability to work in a fast-paced environment.

+ Must possess strong interpersonal, organizational, and project management skills, with the ability to work on multiple tasks simultaneously.

+ Experience in QA/Audit/Systems testing development and execution preferred. Licensure, Certifications, and Clearances:

+ Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran