Job Description

Job Title: Provider Services Liaison
Job ID: 672965
Status: Full-Time
Regular/Temporary: Regular
Hours: Can go to 6pm
Shift: Day Job
Facility: UPMC Health Plan
Department: Provider Services
Location: 1650 Metropolitan Street, Pittsburgh PA 15233

Description

Purpose:

Do you have a strong background in healthcare insurance and claims? Are you comfortable being on the phone and providing customer services? If so, UPMC may have the perfect role for you!


UPMC is currently hiring a full time Provider Services Liaison. This role will develop, administer and maintain analysis functions and special projects related to all lines of business (CM, MC, MA). The Provider Liaison will complete all duties with strict regard to policies and procedures set forth by UPMC, Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and the Pennsylvania Insurance Department (PID). As well, they will interface with internal and external customers via phone and/or correspondence to answer inquiries and investigate, resolve and adjust claims for all product lines.


Responsibilities:
  • Act as a resource in resolving CBO (Central Billing Office) issues, including conducting research and participating in bi-monthly meetings.
  • Assist with phone coverage as needed.
  • Collaborate with management and Training to identify educational opportunities for staff. Participate in training as needed
  • Compile data and generate reports as requested.
  • Develop and implement specific outreach, relationship-building and other strategies for Provider Advocates
  • Identify areas of concern that may compromise provider satisfaction.
  • Maintain a high level knowledge of all lines of business, including adjustments and negative balance. Adjust claims as needed.
  • Maintain employee/insured confidentiality.
  • Measure and evaluate activities including producing and sharing regular summaries of issues
  • Receive and respond to all department inquiries, internal and external, within a timely manner.
  • Track and trend provider and/or claim issues. Contact the appropriate internal department for resolution.
  • Work in conjunction with management to resolve individual provider issues, including contacting other departments for assistance if necessary, and performing provider outreach for resolution.

Qualifications

  • High school diploma required.
  • Bachelor degree preferred.
  • 3+ years of at least one of the following; health insurance experience, internal customer service, call center experience, claim processing and/or claims adjustments.
  • Excellent knowledge in medical terminology, ICD-9 and CPT coding required.
  • High level knowledge of all lines of business, Medicare, Medicaid and Commercial benefits.
  • Excellent organizational, analytical, interpersonal and communication skills.
  • Knowledge of Microsoft Office, Access and Excel spreadsheet program preferred.
  • Competent in claims process operating system.

Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $18.24 to $30.32

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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