At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic continues to evolve. As our recruiters work to fill positions during this time, interviews and recruitment-related processes have been modified to protect and prioritize the safety of our candidates and employees.

UPMC continues to comply with any governmental guidance related to local, state, and federal COVID-19 vaccination and testing requirements where our team members live and work. UPMC strongly supports vaccination and encourages everyone who can get vaccinated to do so to protect themselves, their co-workers, and our patients. At this time, the COVID-19 vaccination is available for new or existing employees on a voluntary basis, except where required by local, state, or federal authorities. Staff in positions in our New York, Maryland, and City of Philadelphia areas must be in compliance with local COVID-19 mandates.

For more information about UPMC’s response to COVID-19, please visit upmc.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Provider Advocate

Description

At UPMC, we’re all here for the same reason – to make Life Changing Medicine happen. Join our team and you will play a unique and important role in our mission to change healthcare for the better.

UPMC Health Plan is hiring a team of full-time Provider Advocates to support the Provider Services department. This is a Monday – Friday daylight role (Service Shifts ranging from 8:00 am to 5:00 pm, depending upon service level need) and is based out of Pittsburgh, PA. This is a hybrid position, with some remote/work-from-home privileges, and some travel to the office (Harbor Gardens location) will be required for orientation/trainings (approximately 10 weeks), as well as for meetings and department needs.

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. Responsible for efficient and courteous resolution to verbal and written inquiries to ensure customer satisfaction while maintaining call servicing and quality standards.

 

Responsibilities:

  • Actively maintain worklist open cutlogs and follow up within the designated time standards.
  • UPMC Health Plan Provider Service Representative must adhere to the following servicelevel standards of excellence:
    Quality: 98% Monthly Average - Production: 60 calls per day.
  • Maintain employee/insured confidentiality.
  • Provide assistance to other departments during periods of backlogs.
  • Assist with adjustments in accordance with company policies and procedures.
  • 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).
  • Interface with customers by telephone or correspondence to answer inquiries and resolve concerns.
  • 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 organization staff.
  • Identify any area of concerns that may compromise client satisfaction.
  • Maintain or exceed designated quality standards.
  • Participate in team meetings, provide ideas and suggestions to ensure client satisfaction and promote teamwork.

Qualifications

  • High school graduate or equivalent.
  • 2 years customer service experience or call center experience required OR 1 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