Provider Advocate - Erie, PA

UPMC • Erie, PA

1d • Hybrid

About The Position

UPMC Health Plan is hiring a team of Provider Advocates to support the Provider Services department. This is a full-time hybrid position based in the Erie, PA area. While you'll primarily work remotely, you'll come into the office occasionally depending on departmental needs. Must be located in or around Erie, PA to be considered. 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 inquiries. Responsible for efficient and courteous resolution to verbal and written inquiries to ensure customer satisfaction while maintaining call servicing and quality standards.

Requirements

• 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.
• Act 34

Responsibilities

• Actively maintain worklist open cutlogs and follow up within the designated time standards.
• Adhere to service level standards of excellence: Quality: 98%25 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.
• Respond 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.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED