Provider Network Advocate - Ancillary Network

About the role

The UPMC Health Plan is seeking a Provider Network Advocate to support network growth through provider onboarding, network management, and strategic initiatives that enhance provider quality and performance. The Provider Network Advocate (PNA) - Ancillary Network will support the Provider Network Liaison (PNL) team and investigate issues with other ISD departments. This role is hybrid, requiring a minimum of 3 days per week onsite in Downtown Pittsburgh, as well as occasional travel throughout the area. This requirement may change to support business needs.

Responsibilities

• Coordinate provider problem resolution as identified through internal reports and by the PNL team or ISD leadership. Identify root causes, swiftly take the needed steps to resolve the issue, and ensure a closed feedback loop to the PNL and provider occurs.
• Present health plan programs and tools to network providers and their office staff. Follow up with providers as necessary to ensure understanding.
• Document provider outreach and initiative progress in a customer relationship database in a timely manner.
• Collaborate with other Network Leaders and staff to ensure process improvement within the department.
• Manage relationships with key providers within the Health Plan provider network as directed.
• Effectively manage special projects as assigned to complete in a timely manner. Occasionally, the employee will need to extend hours beyond a 40-hour work week.
• Outreach to providers related to key departmental goals via phone, email, and personal visits as requested. Investigations and outreach will include provider payment issues, configuration issues, special outreach projects, and HEDIS, HCC, CDPS, MA P4P, and CMS Stars improvement initiatives.
• Ability to attend or accompany Director or PNL to various internal and external department and provider meetings.

Requirements

• Bachelor's Degree in Business, Health Care, Marketing, or a related field is required or equivalent experience.
• 3 years of business/sales or healthcare-related experience required.
• Experience with Provider Services, Medical Claims, Customer Service, or Member Services preferred.
• Proficiency with Microsoft Office highly preferred.
• Strong working knowledge of all business lines preferred.

Skills

• Excellent written and verbal communication skills.
• Ability to document, organize, analyze, and problem-solve.