Job Description

Job Title: Provider Advocate
Job ID: 1700017B
Status:
Regular/Temporary:
Hours:
Shift: Day
Facility:
Department: Provider Services
Location: 1650 Metropolitan Street, Pittsburgh PA 15233

Description

Purpose:

UPMC Health Plan is hiring a full-time Provider Advocate to help support the Provider Services Department. The Provider Service representative acts as an advocate for Health Plan customers (providers, vendors, facilities, etc.) by providing guidance, interpretation and education on eligibility levels, benefit design, claim status, and various customer related inquires. This role is also responsible for efficient and courteous resolution to verbal and written inquiries to ensure customer satisfaction while maintaining call servicing and quality standards. The hours for this position are Monday through Friday, standard daylight hours (8:00AM to 5:00PM).  

Responsibilities:

  • Interface with customers by telephone or correspondence to answer inquiries and resolve concerns.
  • Actively maintain worklist open cut logs and follow up within the designated time standards. 
  • Maintain or exceed designated quality standards. Identify any area of concerns that may compromise client satisfaction. 
  • Participate in team meetings, provide ideas and suggestions to ensure client satisfaction and promote teamwork. 
  • Provide assistance to other departments during periods of backlogs. 
  • Assist with adjustments in accordance with company policies and procedures. 
  • UPMC Health Plan Provider Service Representative must adhere to the following service level standards of excellence: Quality: 98% Monthly Average - Production: 60 calls per day. 
  • Quality customer service includes, but is not limited to, responding to customer requests and inquiries in a timely and accurate manner in keeping with Health Plan Policies and Procedures, Department of Public Welfare (DPW) laws and standards, Department of Insurance (DOI) laws and standards, Department of Health (DOH) laws and standards, Department of Health and Human Services (DHHS), Health Care Financing Administration (HCFA), and National Committee for Quality Assurance (NCQA) standards. 
  • Quality customer service should be applied to all customers, including all Health Plan members and potential members, all Health Plan providers and potential providers, all Health Plan and Health System employees, all Health Plan and Health System vendors, and all government and other oversight organization staff. 
  • Quality customer service will be measured by, but not limited to, the number of complaints from a customer (with a goal of zero) and by the number of second requests for information or response received (with a goal of zero). 
  • Maintain employee/insured confidentiality.

Qualifications

  • High school graduate or equivalent. 
  • Two years customer service experience or call center experience required. OR One year health insurance call center and claims adjustments experience required. 
  • Keyboard dexterity and accuracy. 
  • Excellent knowledge of medical terminology, ICD-9 and CPT-4 coding. 
  • Excellent knowledge of HMO, POS and PPO plans, coordination of benefits, subrogation and Medicare. 
  • Excellent organizational, interpersonal and communication skills. 
  • Competent in MS Office/PC skills. Detail Oriented.

Salary Range: $15.76 to $25.02

Union Position:

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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