Provider Disputes and Appeals Intake Coordinator (Hybrid)- Pittsburgh, PA

UPMC•Pittsburgh, PA

8d•Hybrid

About The Position

The Provider Disputes and Appeals Intake Coordinator manages intake and classification of provider dispute and appeal cases, ensuring case information and supporting documents are entered and maintained accurately and promptly. The coordinator works with providers and internal teams to help ensure concerns are handled efficiently and appropriately, and supports the appeals tracking system and service-operation goals. This is a full-time hybrid position working Monday through Friday during daylight hours. Travel to the office is required for training and/or department business needs.

Requirements

High school graduation or equivalent.
Two years of work experience in claims or customer service required.
Proficiency in typing.
Demonstrate a positive and professional attitude at all times.

Nice To Haves

One year of work experience in claims or customer service preferred.
Managed care or health insurance experience preferred.
Excellent communication, organizational, and customer service skills preferred.
Detail-oriented; knowledge of Microsoft Word and Excel preferred.
Problem-solving and decision-making skills, with a solid understanding of managed care principles; knowledge of all product lines preferred.

Responsibilities

Conduct intake of cases received through written requests and set up new cases in the C&G information system.
Classify provider complaints and appeals based on line of business and appeal rights, conducting appropriate investigation that may include outbound contact.
Access multiple health plan systems to assist with case classification.
Assess, enter, and maintain documents in files and databases accurately and promptly so information is organized and readily available.
Respond to incoming messages through department inboxes, email, or fax accurately and promptly.
Triage and respond to inquiries as appropriate or distribute them as needed.
Retrieve, copy, collate, and file documents associated with provider dispute and appeal processes.
Identify and escalate priority and expedited issues to management in a timely manner.
Support the team's efforts to improve performance against measured service-operation goals.
Complete data entry in various information systems to support C&G processes.
Support implementation of the appeals tracking system.