Job Description

Job Title: Case Management Support Coordinator
Job ID: 719472
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: WKP Comm WC Claims Admin
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC Health Plan is hiring a full-time Case Management Support Coordinator to help support the Workers Compensation Claims Administration Department for its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position.


This position will provide support to Work Partners' Case Management & Network departments through delivery of a wide array of programmatic, operational and administrative responsibilities that will augment the injured worker's, client's and provider's experience regarding coordinated delivery of care as well as enhance communication flow of medical information to and from the office.

Responsibilities:

  • Assist in the generation, distribution, maintenance and evaluation of health care provider panels.
  • Assist with Independent Medical Exam record preparation.
  • Assist with processing of provider profiling information and data change requests.
  • Collaborate with providers, employer clients and/or vendors to evaluate and respond to request, issues and questions in a timely and professional manner.
  • Conduct ongoing entry and maintenance of provider information into a master data repository.
  • Effectively prioritize and complete all assigned tasks.
  • Enter application/contract information into appropriate tracking databases.
  • Follow up and diary all pending medical records to ascertain timely arrival.
  • Follow up with providers for outstanding documents needed to complete the onboarding process.
  • Maintain strict confidentiality related to medical records and other data.
  • Manage all incoming mail for a specified group; Scan and attach all medicals, note and see that any bills for medical records requests are processed.
  • Manage all medical records requests and provide outbound communication to treating providers using phone/fax/email and seeking needed medical required.
  • Manage and triage calls that may not require clinical intervention; transfer calls to appropriate staff member as needed.
  • Perform Quality Audit checks of the contract database.
  • Perform Right Fax administration to include initial review of all faxed material and dissemination of information to correct claim and staff member.
  • Prepare provider application/contract packets and fax/mail/email to provider.
  • Prepare provider data documents, including contracts, for scanning
  • Provide assistance to other departments during periods of backlog as needed.
  • Receive initial referrals for workers' compensation, disability and/or other claims; set up claims and notify appropriate staff member.
  • Respond to phone inquiries from providers.
  • Review all claim validation reports and prepare/disseminate end of month reports to the client.
  • Review received applications/contracts for completeness.

 

Qualifications

  • Bachelors Degree or equivalent work experience in a business environment required.
  • One year in health insurance or claims experience highly preferred.
  • Knowledge of Workers Compensation and/or Disability Management preferred.
  • Knowledge of Insurance, Managed care or Benefits Administration environments preferred.
  • Knowledge of medical terminology preferred.
  • Strong interpersonal and organizational skills required, with the ability to work on multiple tasks simultaneously.
  • Strong computer skills required with competence in MS Office including MS Excel, MS Access, MS Word preferred.

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

Salary Range: $17.11 to $28.43

Union Position: No

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