Job Description

Clinical Service Representative I Location Remote in Pittsburgh, PA :

Job ID: 5673302308 Status: Full-Time Regular/Temporary: Regular Shift: Day Job Facility: UPMC Health Plan Department: UM CM Operations Location: 600 Grant St, Pittsburgh, PA Union Position: No Salary Range: $ 17.78-27.95 USD

UPMC Health Plan's Clinical Operations team is seeking a Clinical Service Representative I! This role is eligible for work-from-home opportunities based on performance and to management's discretion. Hours for this role will vary with shifts scheduled between 8 AM - 8 PM, Monday through Friday.

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. The 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:

• Answer incoming inquiries from UPMC Health Plan members and providers
• Perform callbacks to members/providers to supply authorization decisions
• Conduct and document outbound calls to clarify, follow up and resolve customer inquiries
• Assist with scheduling members medical appointments to ensure that the Health Plan customers receive routing or follow-up care as indicated
• 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
• Facilitate transportation needs
• Complete initial review of all faxed material
• Manage and triage calls and electronic cases that may or may not require clinical intervention
• Create cases in the authorization system when appropriate
• Maintain or exceed designated quality and production standards
• Remain current on all department policies, procedures, plan benefit designs and modification
• Provide assistance to other departments during periods of backlog
• Maintain strict confidentiality related to medical records
• Must adhere to all HIPPA regulations

Qualifications:

• High School Graduate
• 1 year of customer service or call center experience required
• 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 required
• Excellent organizational, communication and problem-solving skills required
• Schedule flexibility to meet business needs
• Detail oriented

  Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

BENEFITS AND LIFE AT UPMC Why Work Here

We know that you have many options when choosing where to build your career. So why choose UPMC? We can think of a few reasons.

Benefits that Matter to You

We're committed to providing benefits that meet your needs and support your well-being in all areas of life.

• Earn over 5 Weeks of Paid Time Off Every Year
• Affordable Medical, Dental & Vision Coverage
• Student loan assistance and tuition reimbursement options
• Earn up to 8% of your eligible pay in retirement contributions from UPMC
• Employer-Paid Life Insurance

Support for You - and Your Family

Your career doesn't impact just you, but the people you care about, too. We're making sure your career works for the whole family.

• Two Weeks of Paid Parental Leave
• Family Planning Resources
• Tuition Assistance for Dependents
• Comprehensive Health Care for Dependents
• Emergency Child and Elder Care Options
• Flexible Work Arrangements

A Culture That Cares

At UPMC, you can find a home among people who share your passions and care about who you are.

• Employee Resource Groups
• Awards for Champions of Dignity & Respect
• Center for Engagement & Inclusion
• Programs for Veteran Engagement

Tools to Reach Your Potential

Once you become a member of our team, the journey doesn't stop there. UPMC is committed to supporting your growth and helping you build the career of your dreams.

• Up to $6,000 of Annual Tuition Assistance
• Ongoing Learning via Linkedin Learning
• Accelerated Career Pathways for Growth
• Robust Instructor-led Education and Learning Pathways

Expansive Opportunity

Where do you want to go with your career? Wherever it is, UPMC can take you there.

• 96,000+ Employees
• 40 Hospitals and 800+ Doctors' Offices and Outpatient Sites
• Dozens of Career Ladders to Climb
• International Locations
• State-of-the-Art Technology

Job Tags

Full time, Temporary work, Work at office, Remote work, Work from home, Flexible hours, Shift work, Monday to Friday,

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