Description
UPMC Health Plan's Clinical Operations team is seeking a Temporary Clinical Service Representative I! This role is eligible for work-from-home opportunities based on performance and to managements discretion. This position will work Monday through Friday, 10 am to 6 pm. This will be a 6 month assignment.
The Clinical Service Representative (level 1) acts as an advocate for Health Plan customers (members, providers, facilities etc.) by providing guidance, interpretation and education on benefit coverage levels, Health management/Case management programs and various program inquiries. Responsible for efficient and courteous resolution of verbal and written inquiries to ensure customer satisfaction while maintaining call service and quality standards. Clinical Service Representative (level 1) will also provide non-clinical support for the Medical Management activities by serving as the first line of contact for utilization management activities.
Responsibilities:
- Facilitate transportation needs
- Perform call backs to members/providers to supply authorization decisions
- Conduct and document outbound calls to clarify, follow-up and resolve customer inquiries
- Create cases in the authorization system when appropriate
- Must adhere to all HIPPA regulations
- Remain current on all department policies, procedures, plan benefit designs and modification
- Provide assistance to other departments during periods of backlog
- Complete initial review of all faxed material
- Manage and triage calls and electronic cases that may or may not require clinical intervention
- Maintain strict confidentiality related to medical records
- Assist with scheduling members medical appointments to ensure that the Health Plan customers receive routing or follow-up care as indicated
- Answer incoming inquiries from UPMC Health Plan members and providers
- Maintain or exceed designated quality and production standards
- Attend offsite/onsite benefit fairs-interact with members and schedule appointments
- Conduct outbound member and provider calls in accordance with department initiatives and regulatory requirements
- Initiate assessments on members by obtaining all necessary member demographics and any available clinical information
Qualifications
- High school graduate preferred
- 1 year of customer service or call center experience preferred
- 1 year clerical, data entry or office experience preferred
- Ability to make independent decisions Medical Terminology or experience in health care environment preferred
- Basic analytical skills necessary to evaluate customer inquiries
- Computer proficiency in database, word processing and spread sheet management preferred
- Excellent organizational, communication and problem-solving skills preferred
- Schedule flexibility to meet business needs
- Detail oriented
Licensure, Certifications, and Clearances:
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.
