PA Office Support Representative

Highmark Health

117d • $20 - $29

About The Position

The position involves receiving, reviewing, and making determinations regarding physician reviewer assignments for medical management decisions. This includes handling provider and member requests from the Medical Management & Policy (MM&P) and Member Grievance Departments. The role is responsible for managing the Peer to Peer telephone line and ensuring compliance with various regulatory requirements. Timely assignment of cases in accordance with standards set by regulatory agencies such as NCQA, URAC, and CMS is crucial. Effective communication and follow-up with internal and external providers and contracted vendors are also key responsibilities.

Requirements

• High School Diploma / GED.
• 3-5 years of related, progressive experience.

Nice To Haves

• Experience in navigating managed care systems.
• Certification or equivalent training in Word Processing, Database Management, or Medical Terminology.

Responsibilities

• Timely receipt, review, and assignment of all incoming physician reviewer referrals and appeals to ensure compliance with NCQA, URAC, CMS, DOH, DOL, and state regulations.
• Management of the physician peer to peer telephone line, including follow-up with providers and provider office staff.
• Efficient coordination of the clinical review process with contracted external review companies.
• Timely sorting and filing of all required case information.
• Data entry, maintenance, and integrity of all databases.
• Other duties as assigned or requested.

What This Job Offers

• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees