Become A Provider

* meal prep, light housekeeping, light patient care and companionship.
* Dependable vehicle is a must, daily travel is required.
* The daily task and schedule is decided daily, you will be covering for a provider if they happen to call-in or if the department has an immediate need.
* Schedule is between Monday thru Friday from 8:30 to 5:00.
* Also will be on-call one weekend out the month.
* Spanish speaker is a must.
* Mileage will be

* Deliver 30- and 60-minute Total Body Stretch sessions to promote members’ and guests’ flexibility, mobility, circulation, injury prevention, recovery and performance as part of the Massage Envy vision of total body care.
* Customize sessions to best meet member and guest needs.
* Make recommendations on frequency, enhancements (when applicable), and home care within the scope of practice.
* Assist in the cleanliness of the location.
* Maintain professional appearance at all times.
* Assist in the promotion of the health and wellness benefits to members and guests receiving stretch therapy on a regular basis; communicate various promotions to members and guests.
* Create excellent member/guest experience through friendly and helpful attitude.
* Reliable, on time attendance.
* Attends all scheduled shifts, is prompt to work and works entire scheduled shift.
* Other duties as assigned

* The candidate will be expected to provide independent clinical services for pediatric general surgery, trauma, transplant, colorectal and burn patients at Children’s Hospital Colorado (CHCO).
* These duties will include primarily inpatient responsibilities such as rounding, writing orders/progress notes, consults, discharge, patient assessment, patient education, care coordination, disease management and minor procedures.
* Duties will also include coverage of outpatient surgical clinics and minor procedures in the clinic.
* Close collaboration with pediatric general surgeons, sub-specialty surgeons, emergency medicine physicians, intensivists, residents/fellows and hospital staff will be necessary.
* Professional interaction with referring physicians and staff, emergency medical personnel and primary care providers is essential.
* The candidate will provide care to patients in the pediatric intensive care unit, newborn intensive care unit, acute care areas, and in the outpatient clinics.
* The work schedule may include up to 13hr shifts, evenings, nights, weekends, and holidays

* Manage unit cost budgets, target setting, performance reporting and associated financial models Predict emerging customer needs and develop innovative solutions to meet them Help develop geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards, and other key process controls Ensure that network composition includes an appropriate distribution of provider specialties Get ready for a high impact role.
* You'll be tasked with working in conjunction with our national clinics and hospitals to manage, collect and analyze provider data, updating and loading provider data and resolving any escalated issues with the clients

* Actively maintain worklist open cutlogs and follow up within the designated time standards.
* Assist with adjustments in accordance with company policies and procedures.
* Identify any area of concerns that may compromise client satisfaction.
* Interface with customers by telephone or correspondence to answer inquiries and resolve concerns.
* Maintain employee/insured confidentiality.
* Maintain or exceed designated quality standards.
* Participate in team meetings, provide ideas and suggestions to ensure client satisfaction and promote teamwork.
* Provide assistance to other departments during periods of backlogs.
* Quality customer service includes, but is not limited to, responding to customer requests and inquiries in a timely and accurate manner in keeping with Health Plan Policies andProcedures, Department of Public Welfare (DPW) laws and standards, Department ofInsurance (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.
* Quality customer service should be applied to all customers, including all Health Planmembers and potential members, all Health Plan providers and potential providers, allHealth Plan and Health System employees, all Health Plan and Health System vendors,and all government and other oversight organization staff.
* Quality customer service will be measured by, but not limited to, the number of complaints from a customer (with a goal of zero) and by the number of second requests for information or response received (with a goal of zero).
* UPMC Health Plan Provider Service Representative must adhere to the following servicelevel standards of excellence: Quality: 98% Monthly Average
* Production: 60 calls per day.
* Qualifications
* High school graduate or equivalent.
* Two years customer service experience or call center experience required.
* OR One year health insurance call center and claims adjustments experience required.
* Keyboard dexterity and accuracy.
* Excellent knowledge of medical terminology, ICD
* and CPT
* 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.
* Licensure, Certifications, and Clearances:
* UPMC is an equal opportunity employer.
* Minority/Females/Veterans/Individuals with Disabilities
* REQNUMBER