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   Current UPMC employees must apply in HR Direct

Provider Service Advocate

Description

UPMC Health Plan is hiring a full-time Provider Advocate to help support the Provider Services Department. The Provider Service representative acts as an advocate for Health Plan customers (providers, vendors, facilities, etc.) by providing guidance, interpretation, and education on eligibility levels, benefit design, claim status, and various customer-related inquires. This role is also responsible for an efficient and courteous resolution to verbal and written inquiries to ensure customer satisfaction while maintaining call servicing and quality standards. 

 

Responsibilities:

  • Interface with customers by telephone or correspondence to answer inquiries and resolve concerns.
  • Actively maintain worklist open-cut logs and follow up within the designated time standards. 
  • Maintain or exceed designated quality standards. Identify any areas of concern that may compromise client satisfaction. 
  • Participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork. 
  • Provide assistance to other departments during periods of backlogs. 
  • Assist with adjustments in accordance with company policies and procedures. 
  • UPMC Health Plan Provider Service Representative must adhere to the following service level standards of excellence: Quality: 98% Monthly Average - Production: 60 calls per day. 
  • Quality customer service includes, but is not limited to, responding to customer requests and inquiries in a timely and accurate manner in keeping with Health Plan Policies and Procedures, Department of Public Welfare (DPW) laws and standards, Department of Insurance (DOI) laws and standards, Department of Health (DOH) laws and standards, Department of Health and Human Services (DHHS), Health Care Financing Administration (HCFA), and National Committee for Quality Assurance (NCQA) standards. 
  • Quality customer service should be applied to all customers, including all Health Plan members and potential members, all Health Plan providers and potential providers, all Health Plan and Health System employees, all Health Plan and Health System vendors, and all government and other oversight organizations staff. 
  • Quality customer service will be measured by, but not limited to, the number of complaints from a customer (with a goal of zero) and by the number of second requests for information or response received (with a goal of zero). 

 

 

Qualifications

  • High school graduate or equivalent.
  • 2 years of customer service experience or call center experience required.OR1 year health insurance call center and claims adjustments experience required.
  • Keyboard dexterity and accuracy.
  • Excellent knowledge of medical terminology, ICD-9, and CPT-4 coding.Excellent knowledge of HMO, POS, and PPO plans, coordination of benefits, subrogation, and Medicare.Excellent organizational, interpersonal, and communication skills.
  • Competent in MS Office/PC skills.Detail Oriented.


Licensure, Certifications, and Clearances:

  • Act 34

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct