Job Description

Job Title: Coordinator, Customer Service - Community Care Behavioral Health
Job ID: 744945
Status: Full-Time
Regular/Temporary: Regular
Hours: 11:30 p.m. to 8 a.m.
Shift: Night Job
Facility: Community Care Behavioral Hlth
Department: Member Services
Location: 339 Sixth Avenue, Pittsburgh PA 15222

Description

UPMC Community Care and Behavioral Health is hiring a full-time Coordinator, Customer Service to supervise the Member Services Department at its downtown Pittsburgh location at Heinz 57 Center. This position will work an 11:30 p.m. to 8:00 a.m. schedule Tuesday through Saturday, but the schedule may vary as needed.  The ideal candidate will have previous supervisory and call center experience. 


The Coordinator of Customer Services has overall responsibility for managing daily operations for the unit. This individual is responsible for the administrative supervision and management of the specified customer service teams. The Coordinator ensures provision of customer services consistent with all applicable policies and procedures and represents the organization to providers, member groups and families, and participates in overall operations management as warranted.

Responsibilities:

 

  • Active participant on the call center management team; driving success for the call center.
  • Acts with the authority of the Manager of Customer Services when designated.
  • Assumes daily responsibility for the education & referral activities provided to Community Care members and providers through the customer services department.
  • Complete special projects and performs related duties as assigned.
  • Coordinates the complaint and grievance process for members and providers.
  • Coordinates, reviews and maintains data for reporting purposes and for preparation and analysis of trending reports as needed.
  • Maintains an up-to-date understanding of benefits, in-plan and supplementary services, and the regulatory environment and remains current on covered benefits, limitations, exclusions, and policies and procedures and the specifics of all contracts.
  • May engage in the acquisition or transfer of structured clinical data, but does not engage in any activities that involve clinical evaluation or interpretation.
  • Measure procedures effectiveness focusing on the improvement of service for member/providers; make recommendations for procedure improvements; implement changes as needed; set up a process for maintain reporting on procedures.
  • Meets with members and families, primary care and behavioral health providers, and other agency staff as needed to develop and coordinate member and provider educational opportunities.
  • Monitors daily activity to ensure that services of the department are provided within NCQA, URAC and DHS, and other internal and external standards.
  • Orients, trains, and oversees Customer Services staff; and conducts performance reviews as required by organizational policies.
  • Participates in CQI activities and provider training, and participates in professional development activities.
  • Participates in making presentations to participating providers, state and federal agencies, community groups and other interested parties.
  • Provides accurate information concerning benefits and coverage to staff or other persons as required.
  • Provides oversight of the teams providing education, benefit information, and referral assistance to all Community Care members and providers.
  • Receives and responds to complex calls and assists Customer Services staff to resolve complex issues.
  • Responsible for directly assisting daily operations of the Customer Services department when scheduled staff are unable to perform their duties.
  • Utilizes supervision effectively. Reports call center and data entry issues to Manager of Customer Services. Identifies member and provider issues and recommendations for improvement.
  • Works closely with the manager in the continued development of the customer services department.
  • Works with Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented.
  • Works with internal network staff and providers to identify areas for the development of additional services to best meet members' needs and access standards.


Qualifications

  • Bachelors or Associates degree with related experience and/or equivalent work experience.
  • Five years of customer services &/or call center experience required
  • Call center experience strongly preferred
  • Ability to handle multiple lines of business preferred
  • Experience in behavioral health &/or managed care strongly preferred
  • Supervisory experience managing 24 hour operation strongly preferred
  • Strong leadership skills and abilities; strong, independent decision-making ability is a must.
  • Experience in training and coaching staff required.
  • Knowledge of managed care functional areas, including terms and definitions, required
  • Strong writing and computer skills
  • Complete and thorough understanding of "Excellence in Service" requirements
  • Valid driver's license preferred.

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

Salary Range: $26.64 to $44.88

Union Position: No

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