Veteran Care Representative

at  UPMC

Join our team of Life Changers!
UPMC is hiring a Full-Time, Veteran Care Representative to support the office in Harrisburg.
Looking to add someone who is customer driven, has experience with completing referrals, knowledge of Veteran Affairs and has a passion to serve our Veterans to this dynamic team.

• Manages incoming calls from clinics, patients, and VA Medical Centers, in-basket messages, and emails on a timely basis.
• Receives referrals from VA Medical Centers.
• Conducts review of documentation ensuring all aspects of required documentation are present.
• Requests additional required documents as needed.
• Processes all aspects of referrals from the initiation of the referrals in the utilized electronic medical record, to include, but not limited to, transcription of orders, uploading of all documents, annotation of all required documentation, adjusts and correct insurance filing orders and location of services.
• Utilize associated data platforms from external agencies to retrieve referrals (HSRM).
• Schedules appointments across all service lines, creates and assigns referrals, creates and assigns HAR, adjusts permanent patient notes, addends clinical schedule and appointment notes.
• Coordinates with service lines for all required services to include appointments, records, and care coordination between entities.
• Accurately documents all aspects of care coordination through the EMR, Teams Tracker, and portal with patients and staff.
• Maintains referral log accurately and utilizes such to accurately inform VA medical centers and patients of accurate locations of services to include TIN/NPI.
• Coordinates with external and independent healthcare providers when veterans are utilizing shared VA authorizations.
• Reviews procedures requested by agencies regarding coverage based on CPT coding.
• Returns required information for approval, next steps, or declination by the VA medical center.
• Supports service line staff with claim edit work queue errors.
• Assists patients with billing questions related to referrals and communicates patient billing inquiries to the Professional or Hospital Billing Office.
• Assists veteran in enrolling in VA coverage through the coordination with embedded Veterans Affairs medical center community liaisons.
• Utilizes VA medical center staff to confirm eligibility for services.
• Communicates issues to service lines and supervisors as necessary regarding coverage.
• Assist in submitting emergency and inpatient authorization requests.
• Appropriately utilizes supervisory team for outlier issues, problems, or difficulties.
• Performs in accordance with system wide competencies and behaviors.
• Performs other duties as assigned.
• High School diploma required.
• Additional training in a medical setting or field with a knowledge of basic medical terminology is preferred.
• Four years of experience working in a health care environment preferred or an equivalent combination of education and experience.
• Strong interpersonal and communication skills, and computer literacy/data entry skills are required.
• High level of independence required in problem solving activities.
• Strong organizational skills that will generate efficiency & effectiveness.
• Adaptable to change.
• Ability to handle multiple tasks in a fast-paced environment & function independently.
• Must be able to prioritize referrals.
• Ability to analyze issues objectively & provide workable solutions & implement those actions with support of supervisory team.
• Team player, flexible, and innovation oriented are ideal.Licensure, Certifications, and Clearances:
• Act 34