Purpose:
Are you passionate about building strong provider partnerships and solving complex challenges that improve the healthcare experience? As a Provider Network Advocate (PNA) Senior, you'll serve as a trusted advisor to providers and internal stakeholders, leading issue resolution efforts, driving operational improvements, and supporting initiatives that enhance provider performance, quality outcomes, and member satisfaction.The Provider Network Advocate (PNA) – Senior will support the Director, Network Management and the Provider Network Liaison (PNL) team, holding a senior role within the Provider Network Advocate (PNA) team. The PNA Senior will coordinate and investigate complex issues with other Insurance Services Division departments, identifying root causes and take action to resolve the issue. The PNA Senior will assist with provider operational initiatives, issues investigation and resolution including provider payment issues, configuration issues, special outreach projects and HEDIS, HCC, CDPS, MA P4P, and CMS Stars improvement initiatives. The PNA - Senior will assist the PNL team, oversee and guide other PNA staff to investigate issues and effectively communicate findings to PNLs, providers and other departments. The PNA Senior will outreach to providers related to key departmental goals via phone, email and personal visits as requested. Provider outreach and initiative progress will be documented in a customer database.
This position is Hybrid and requires in-office work 3 days per week in Downtown Pittsburgh.
Responsibilities:
- Present HP programs and tools internally to PNLss, other PNAs, and other ISD departments as necessary.
- Present programs and tools to network providers and staff.
- Follow up with provider as necessary to ensure understanding.
- Act as a resource to PNLs and other PNAs.
- Train new staff as directed.
- Coordinate problem resolution for providers 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 closed feedback loop to the PNL and/or provider occurs.
- Document provider outreach and initiative progress in a customer relationship database in a timely manner.
- Facilitate face-to-face visits with providers as directed.
- Foster strong relationships through collaboration with PNLs, other PNAs, other Network leaders, and other Provider Strategy and Performance staff to ensure process improvement within the department and between departments.
- Ability to manage relationships with key providers within the Health Plan provider network.
- Effectively lead and manage special projects assigned by the Department Director, and work collaboratively with the PNLs and other Network team members.
- To complete assigned tasks and projects in a timely manner, occasionally, the employee will need to extend hours beyond 40 hour work week.
- Bachelor's Degree in Business, Health Care, Marketing or a related field is required or equivalent experience.
- 5 years business/sales or healthcare-related experience required.
- Preference will be given to candidates with 2+ years of health-related experience.
- Excellent written and verbal, communication skills, as well as the ability to document organize, analyze and problem solve required.
- Ability to attend or accompany Director or PNL to various internal and external department and provider meetings.
- Experience with Medical Claims, Power BI, and Excel are a bonus.
UPMC is an Equal Opportunity Employer/Disability/Veteran
Must be legally authorized to work in the United States, without requiring, now or in the future, sponsorship for employment visa status. UPMC does not participate in STEM OPT