Job Description

Job Title: Supervisor, Provider Services
Job ID: 670481
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Provider Services
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:

Are you a strong leader with experience in a high volume call center environment?  Are you looking to lead a dynamic and collaborative team?  If so, an opportunity with UPMC Health Plan as a Supervisor, Provider Services may be the ideal next step for your career.  This role will allow you to act as an advocate for Health Plan customers (member, provider, facilities, etc.) by providing guidance, interpretation and education on eligibility levels, benefit design, claim status, and various customer related inquires. The Supervisor is responsible for daily operations of a Customer Service Team and the daily oversight and front line management of Provider Advocate team members. The Supervisor will manage daily staffing, develop and provide training to team members, assess the operational patterns of calls into the center and make recommendations to improve performance. If this sounds like the perfect fit for you, apply today!

Responsibilities:
  • Ability to research and resolve complex claims issues, and conduct provider and staff education.
  • Acts as the liaison between Network Management, Providers and Operations;
  • Analyze and summarize special projects utilizing Microsoft Excel
  • Assists in ongoing training initiatives for all Team Members. Serve as a mentor as assigned for newly hired staff members;
  • Conducts outbound calls to clarify follow up, and resolve inquiries from internal and external customers.
  • Conducts outbound service calls in accordance with departmental initiatives
  • Develop the agenda from current issues and trends that are identified and conduct regularly scheduled team meetings;
  • Documents all inquiries in accordance with UPMC Health Plan guidelines;
  • Establish a schedule of service calls (telephonic or personal visit) with key providers;
  • Follow up on/documents actions required to service inquiry from UPMC Health Plan customers;
  • Front line analyst for Staff Member questions or concerns;
  • Functions as technical expert for their team; Ability to understand and effectively communicate information regarding multiple or complex product line or function;
  • Interact professionally with all customers by telephone or correspondence to answer inquiries and resolve concerns;
  • Investigates and responds to incoming inquiries from UPMC Health Plan customers, internal/external;
  • Meet deadlines and turnaround times set by managers and department director (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both);
  • Meets with team members on an ongoing basis to review trends, changes and quality/production results;
  • Monitors and reports on issues/trends in the unit;
  • Participate in interviewing, hiring, and training of team members. Maintain a positive work environment through employee recognition and interaction.
  • Partner with Network Management in building effective working relationships with key providers;
  • Prepare employee performance reviews. Meet with team members on a monthly basis to provide ongoing feedback and training.
  • Provide exemplary customer service by being proactive and responsive to all UPMC Health Plan customer requests.
  • Provides daily communication to team members related to processing/departmental changes
  • Provides ongoing communication to Individual Staff Members;
  • Record and maintain statistics for staff and the department. Provide coaching and development, and participate in career pathing for staff.
  • Remain current on all departmental policies, procedures, plan benefit designs and modifications
  • Solves problems and provides immediate feedback to Staff Members/Internal/External Customers;
  • Strong knowledge of claims and adjustment process, including offsets and negative balances.
  • Supervise and monitor ongoing performance of team members. Continually examine team performance against department standards.
  • Work in conjunction with other management to allocate and adjust team resources as daily needs require. Responsible for achieving Service Level and ASA goals according to department standards as part of the Management staff.

Qualifications

  • Bachelors degree in business, health care or management related field or equivalent experience. 
  • 3-5 years experience in Insurance, Managed Care, or Benefits Administration environment or equivalent experience preferred.
  • 3 years leadership experience (leading, mentoring, coaching, or teaching)
  • Prior high-volume call-center, customer service, claims, and/or, managed care/insurance industry experience required. 
  • Excellent organizational, interpersonal and communication skills. 
  • Expert knowledge of medical terminology, ICD-9, ICD-10, and CPT-4 coding. 
  • Strong analytical ability. MS Office/PC skills.

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

Salary Range: $22.60 to $39.11

Union Position: No

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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!

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DIGNITY & RESPECT
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