Quality Improvement Information Specialist (171465)

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-9 code 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