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   Current UPMC employees must apply in HR Direct

Supervisor, Provider Advocate

Description


The Supervisor, Provider Advocate acts 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 to our Ancillary and TPA team. 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. To successfully perform the role the Supervisor must understand the causes of customer concern and have the ability to communicate these findings to Call Center Management as well as various internal and external parties. The Supervisor must use their knowledge and understanding of call trends and other information generated by numerous sources to identify opportunities to improve call center performance. Furthermore, the position requires the ability to articulate these opportunities to internal and external audiences, implement the solutions, and track and monitor progress. These functions must be done while also weighing the practical considerations and potential barriers that need to be overcome to successfully implement new programs and processes.

Responsibilities:

 

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

 

Qualifications

  • Bachelor's degree in business, health care or management related field or equivalent experience;.
  • 3-5 years' experience in Insurance, Managed Care, or Benefit's 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 and CPT-4 coding. Strong analytical ability. MS Office/PC skills.
  • Previous dental experience preferred. 


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct