Quality Improvement Information Specialist (171465)
Job Description
Job Description
Quality Improvement Information Specialist (171465)
Pay: $25 – $30 per hour
Schedule:
- 8:00 AM – 4:30 PM (with 1-hour lunch) or
- 8:00 AM – 4:00 PM (with 30-minute unpaid lunch)
Location:
- Harrisburg, PA 17120
Summary:
Support role focused on triaging fraud/abuse referrals and hotline tips, completing balance billing cases, assisting with claims/data review, and supporting reporting/audit-related tasks. Work includes data investigation, documentation of findings, provider outreach, case tracking/follow-up, and preparing written materials (memos, letters, reports). May require travel with advance notice (reimbursed per CWOPA travel regulations for department-required travel only).
Requirements
- Basic medical claims knowledge
- Knowledge of CPT , HCPC , and ICD-9code sets
- Familiarity with medical terminology
- Strong data entry skills and attention to detail
- Strong organization, prioritization, and deadline management
- Strong written and verbal communication + customer service
- Ability to work independently and in a team environment
- PC skills in a Windows environment, including: Microsoft Word, Outlook, Excel, Access
- Data analysis / data warehousing knowledge preferred
Keywords: Program Integrity , Medical Claims , Paid Claims Analysis , Fraud/Abuse Referral Triage , Hotline Tip Triage , Claims Investigation , Retrospective Review , Documentation Review , Case Tracking , Provider Outreach , Balance Billing , Claims Adjustments , Gross Adjustments , Recovery Reporting , Audit Support , Microsoft Excel , Microsoft Access , Medical Terminology , CPT , HCPCS , ICD-9
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