COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Provider Relations Representative - Moosic, PA

  • Job ID: 641154263
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Network Mgt-Sat NC-SCR
  • Location: 72 Glenmaura National Boulevard, Moosic PA 18507
  • Union Position: No
  • Salary Range: $20 to $33.22 / hour

Description

UPMC and Community Care Behavioral Health (CCBH) have an exciting opportunity for a Provider Relations Representative based in Moosic, PA . This is a Monday through Friday daylight role (regular, full-time) with hybrid work arrangements. This position requires occasional reporting to the office for supervision and training, as well as any meetings that are required. The candidate should anticipate reporting regularly to the office during the training period in the first 6 months. 

Initiate and develop working relationships with external providers. Manage primary caseload of assigned providers for whom he/she is the principal point of contact, and cover other caseloads from time-to-time as circumstances require. Assure that the provider is fully educated as to appropriate policies and procedures for conducting business with Community Care. Present comprehensive knowledge of the authorizations and claims functions, credentialing requirements, the application and contracting process, and other topics of general and specific interest to the provider. Adequately, be well versed in the differences between the commercial, Medical Assistance and all other products, with an emphasis on differences in the providers' obligations for each.

Responsibilities:

  • Assure that providers meet the clinical needs of enrolled consumers while continuing to comply with service delivery standards.
  • Share responsibilities with other department personnel for answering the provider line.
  • Establish excellent working relationships with a defined panel of providers.
  • Work with the Director, Provider Relations and other staff as appropriate to develop the provider manuals and handbooks; this process will involve provider input as well as advice from appropriately designated advisory groups.
  • Develop and implement an Action Plan in response to each provider service call.
  • Participate in development and delivery of provider orientation and for follow-up as needed with assigned group.
  • Work with colleagues on development of provider newsletter and other educational materials.
  • Assure that assigned providers have current copies of all relevant educational materials, including the billing handbook and provider manual; is responsible for accurate interpretation of materials to providers in a consistent fashion and for identifying and proposing solutions to problems as they arise.
  • Work as member of the Provider Relations staff, ensure that corrective action plans are implemented and result in complete problem resolution.
  • Responsive to deadlines; complete assignments within deadlines.
  • Meet or exceed specified goals for the number of provider service meetings on a quarterly basis.
  • Balance time and effort spent on external provider servicing with in-office responsibilities.
  • Coordinate service schedule with other Service Reps to ensure adequate and consistent phone coverage.
  • Implement use of quality indicators for use within the network, including work with providers as necessary to assure full understanding and compliance.
  • Manage supplemental service enrollment process for his/her designated panel of providers.
  • Understand and communicates the details of the authorization process and Community Care's procedures for delivering the authorizations to providers.

Qualifications

  • B.A .or B.S. degree in a healthcare, human services or related field.
  • 2 years of experience working in a complex organizational environment.
  • 2 years of experience in healthcare or managed care environment
  • Experience with Microsoft Office and SharePoint strongly preferred. 
  • Independent problem-solving skills, including the ability to address issues in a timely and accurate manner.
  • Knowledge of public and private delivery systems in behavioral health care.
  • Experience as a provider of behavioral health services and/or knowledge of behavioral health provider system strongly preferred.
  • Excellent written and oral communication skills.
  • Must clearly and consistently articulate standards of care and specifics of the various provider agreements.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

Security Alert

We are aware of scams targeting UPMC and other large companies that involve individuals posing as employees to illegitimately conduct interviews and extend false employment offers and payments to gain access to candidates' personal information. Please note that UPMC will not communicate with candidates through third-party email services like Gmail or Yahoo. While some interviews may take place via a video conferencing service, UPMC Talent Acquisition will not conduct interviews via Skype or Google Hangouts. UPMC will never ask for or disburse funds during the recruitment process. If you are hired into a role with a sign-on bonus or similar incentive, funds will be paid to you by UPMC after your start date.

If you suspect you have been a victim of a fraudulent UPMC job offer, please report the attempt using this form.