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   Current UPMC employees must apply in HR Direct

Data Management & Strategy Support Specialist

  • Job ID: 882156665
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Workers Comp Case Mgmt
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $21.91 to $37.83 / hour

Description

The Data Management and Strategic Support Specialist is responsible for panel development and panels vendor management for UPMC WorkPartners' workers' compensation commercial and self-insured clients. The Data Management and Strategic Support Specialist is also responsible for ensuring panel quality, assisting with provider and panel data analysis, and furthering the development of the data analysis tools used to measure compliance through testing and feedback. This position will assist the team with research and development of new tools, processes, and continual growth of the panel management program. The Data Management and Strategic Support Specialist will field basic client communications. This position will also provide support to and work alongside WorkPartners' network and provider relations managers in the delivery of a wide array of administrative responsibilities that will augment the injured workers, clients and providers? experience regarding coordinated delivery of care following a workers' compensation injury.

Responsibilities:

 

  • Performs other duties as assigned.
  • Performs in accordance with system-wide competencies/behaviors.
  • - Oversee vendor accountability by monitoring vendor product quality and turnaround times.
  • - QA and approve electronic data interchange (EDI) files from vendor partners for panel distribution process.
  • - Identify panel opportunities and make suggestions to positively impact productivity in terms of timeliness and accuracy.
  • - Assist in compliance duties by keeping provider data maintained and up-to-date by verifying address, phone number, contact information and TIN on a rolling basis; enter new and updated provider data into panels manager database.
  • - Assist team members in keeping panels up-to-date by ensuring panels meet client?s geographical needs.
  • - Play key role in maintaining and updating provider phase-work files for vendor partners; work with vendor partner to integrate provider data changes into panel updates.
  • - Assist senior level team members in maintaining service account email inbox by responding to client and internal departmental communications in a timely and efficient manner; update client customization records as needed.
  • - Assist network and provider relations managers by entering application/contract information into appropriate tracking databases; add new network contracts and provider locations as needed.
  • - QA new panel files; maintain and file panels per established standards for departmental use (including Medical Management, Underwriting and Claims).
  • - Assist on team projects as needed.
  • - Act as point for daily panel creation. Maintain and track records of client-specific requests, customization, approvals and receipts of EDI transfers to support a personalized relationship with each client.

 

Qualifications

  • Bachelor's Degree required preferably in Business, Finance, Health Sciences, Communications, Public Health or Healthcare Administration with 1 year of experience in related field;
  • or Associates degree and 3 years of experience in related field;
  • or 5 years of experience in related field. -
  • Must have solid analytical skills; attention to detail required.-
  • Experience in logistics, healthcare and workers' compensation preferred.-
  • Customer Services experience required.-
  • Strong presentation and communication skills (written and oral); ability to deliver presentations required.-
  • Excellent computer skills; advanced working knowledge of Microsoft Excel.-
  • Excellent planning, documentation and organizational skills required.-
  • Demonstrated ability to work independently, take initiative and be self-motivated.-
  • Ability to effectively prioritize and complete all assigned tasks.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct