QA Reviewer III-Claims - (Pittsburgh, PA)

Position summary Position title: QA Reviewer III-Claims Job ID: 624434 Status: Full time Regular/Temporary: Regular Hours: Shift: Day Facility: UPMC Health Plan Department: Quality Assurance Location: 600 Grant St, Pittsburgh PA 15219 Description Purpose: UPMC Health Plans Quality Assurance Department is seeking a Quality Assurance Reviewer III- Claims! Responsible for quality review and or internal audit of processed claims, including behavioral health claims and work flows. Performs higher level auditing functions, including peer review of audited claims and auditing to ensure Health Plan compliance for all lines of business. Assists in the development of QA department policies/procedures. Serves as policy and procedure expert for claims auditing functions. Retrieves, distributes and monitors random audit reports. Maintains QA department auditing and training tools. Provides training and assistance to QA staff.