Quality Facilitator

Company: UPMC Location: Pittsburgh, PA 15123 Status: Full Time, Employee Job Category: Medical/Health Career Level: Experienced (Non-Manager) Company: UPMC Reference Code: 1040486UPMC is an integrated global health enterprise headquartered in Pittsburgh, Pennsylvania, and one of the leading non-profit health systems in the United States. As western Pennsylvania’s largest employer, with 48,000 employees and nearly $7 billion in revenue, UPMC is transforming the economy of the region into one based on medicine, research, and technology. By integrating 20 hospitals, 400 doctors’ offices and outpatient sites, long-term care facilities, and a major insurance plan, UPMC has advanced the quality and efficiency of health care and developed internationally renowned programs in transplantation, cancer, neurosurgery, psychiatry, orthopedics, and sports medicine, among others. UPMC is commercializing its medical and technological expertise by nurturing new companies, developing strategic business relationships with some of the world’s leading multi-national corporations, and expanding into international markets; including Italy, Ireland, the United Kingdom, and Qatar. For more information about UPMC, visit our website at www.upmc.com. Quality Facilitator Summary:The UPMC Health Plan is seeking a Quality Facilitator for our Claims Operations department located in downtown Pittsburgh.  The Quality Facilitator is responsible for the quality review, monitoring & mentoring of staff. The Quality Facilitator serves as policy and procedural expert and interfaces with staff & the Training department to meet or exceed quality performance requirements.  The standard schedule for this position is Monday through Friday regular daytime business hours. Responsibilities:·  Develop and/or conduct training programs for the TPA claims department related to product knowledge, procedures, customer service and UPMC Health Plan initiatives.·  Participate in the development/refinement of policies and procedures.·  Develop and/or conduct department training for UPMC Health Plan employees.·  Monitor individual/department quality performance.·  Serves as a quality coach for staff, mentors staff on product/procedural knowledge as well as analytical skills.·  Identifies error trends to determine appropriate training needs. ·  Participates in all training programs to develop a thorough understanding of the materials presented to the claim and service staff.·  Understands the team’s performance against designated quality standards. Qualifications:·  High school graduate, college degree preferred.  ·  Three to five years of health insurance experience, claims processing/auditing experience preferred.·  In dept knowledge of medical terminology, ICD-9 and CPT-4 coding.·  In depth knowledge of HMO, POS, PPO, Medicaid & Medicare plans.·  Excellent organizational, interpersonal, and communication skills.·  Knowledge of COB, subrogation, Medicare and Medicaid preferred.·  MS Office/PC Skills including Excel, Word, and Access.·  Demonstrated analytical skills required.·  Working knowledge of the MC400 system required.·  Attention to detail.·  Ability to work independently and within established tasks timeframes. Keywords:·  Medical claims processing, ICD-9, CPT-4, quality standards, trainer, Medicare UPMC offers a variety of benefit options designed to provide personal security, convenience, and assistance to you and your family. With this flexibility and choice, you can decide which options best meet your needs. Apply at www.upmc.com by following these steps; click Careers at UPMC, Start My Job Search, and follow the link to continue to search and apply for openings. Select Advanced Search and enter 1040486 in the job opening ID field.  UPMC is an equal opportunity employer.