UPMC WorkPartners is hiring a full-time Case Management Support Coordinator to support the Workers Comp Case Management department. This role will work in a hybrid structure with the majority of time working from home, but will require weekly attendance at the office in downtown Pittsburgh. This role will work Monday through Friday, standard daylight hours.

This position will provide support to Work Partners' Case Management & Network departments through delivery of a wide array of programmatic, operational and administrative responsibilities that will augment the injured worker's, client's and provider's experience regarding coordinated delivery of care as well as enhance communication flow of medical information to and from the office.

Responsibilities:

• Perform Right Fax administration to include initial review of all faxed material and dissemination of information to correct claim and staff member.
• Manage all incoming mail for a specified group; Scan and attach all medicals, note and see that any bills for medical records requests are processed.
• Perform Quality Audit checks of the contract database.
• Manage and triage calls that may not require clinical intervention; transfer calls to appropriate staff member as needed.
• Assist with Independent Medical Exam record preparation.
• Review received applications/contracts for completeness.
• Effectively prioritize and complete all assigned tasks.
• Follow up with providers for outstanding documents needed to complete the onboarding process.
• Assist with processing of provider profiling information and data change requests.
• Maintain strict confidentiality related to medical records and other data.
• Conduct ongoing entry and maintenance of provider information into a master data repository.
• Enter application/contract information into appropriate tracking databases.
• Receive initial referrals for workers' compensation, disability and/or other claims; set up claims and notify appropriate staff member.
• Review all claim validation reports and prepare/disseminate end-of-month reports to the client.
• Prepare provider data documents, including contracts, for scanning
• Provide assistance to other departments during periods of backlog as needed.
• Collaborate with providers, employer clients and/or vendors to evaluate and respond to request, issues and questions in a timely and professional manner.
• Effectively prioritize and complete all assigned tasks.
• Assist in the generation, distribution, maintenance and evaluation of health care provider panels.
• Manage all medical records requests and provide outbound communication to treating providers using phone/fax/email and seeking needed medical required.
• Prepare provider application/contract packets and fax/mail/email to provider.
• Respond to phone inquiries from providers.
• Follow up and diary all pending medical records to ascertain timely arrival.

Qualifications:

• Bachelor's Degree or equivalent work experience in a business environment required.
• One year in health insurance or claims experience highly preferred.
• Knowledge of Workers' Compensation and/or Disability Management preferred.
• Knowledge of Insurance, Managed care or Benefits Administration environments preferred.
• Knowledge of medical terminology preferred.
• Strong interpersonal and organizational skills required, with the ability to work on multiple tasks simultaneously.
• Strong computer skills required with competence in MS Office including MS Excel, MS Access, MS Word preferred.
  Licensure, Certifications, and Clearances:
• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

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