Provider Advocate - Tribal Operations - Remote in NM

UnitedHealth Group; Albuquerque (NM); Remote; Confidential; Full time

Job summary

An established industry player is seeking a dedicated professional to join their team in Albuquerque. This full-time position offers the opportunity to make a significant impact on the health care system by ensuring compliance with contracts and enhancing provider relations. You will work collaboratively with cross-functional teams to improve internal tools and resources, analyze data to identify trends, and develop strategies to fill network gaps. If you are passionate about making a difference in the health care landscape and possess strong claims processing experience, this role is perfect for you. Join a company that values diversity, equity, and inclusion, and help create healthier communities.

Benefits

Comprehensive benefits package

401k contribution

Incentive and recognition programs

Equity stock purchase

Qualifications

• 2+ years of claims processing experience required.
• Must have experience with Medicaid or Managed Care Contracts.

Responsibilities

• Confirm contract compliance and conduct advocacy activities.
• Analyze data to identify trends and resolve issues.

Skills

Claims Processing

Communication Skills

Data Analysis

Time Management

Education

High School Diploma / GED

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Facets

Job description

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This position is full-time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work any shift schedules during our normal business hours of 8:00 am - 5:00 pm CST. It may be necessary, given the business need, to work occasional overtime.

If you are located in New Mexico, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Confirm contract compliance to meet the needs of the Turquoise Care contract
• Experience working with providers/facilities to conduct advocacy activities with ITU’s
• Work with cross-functional teams within UnitedHealthcare including but not limited to behavioral health, physical health, dental and vision
• Work with internal groups to identify, understand, and/or improve internal tools, resources, systems, and capabilities that can maximize provider and member experience
• Analyze data to determine root cause of issue (e.g., identify trends and patterns; identify outliers and anomalies) and/or escalate problem to appropriate group for further analysis as necessary

Included in this role is the full range of provider relations and service interactions within UHG, including working on end-to-end problem resolution. Identifies network gaps and assists in the development and implementation of strategies to fill these gaps.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 2+ years of experience with claims processing in Facets
• Experience with Medicaid OR previous Managed Care Contract (MCO)
• Experience with Microsoft office programs including Microsoft Word (creating and editing documents), Microsoft Excel (creating spreadsheets) and Microsoft Outlook (managing e-mail and calendar)
• Experience with communicating clearly and professionally with Providers
• Ability to travel locally up to 10% of the time
• Ability to work between the hours of 8:00 AM - 5:00 PM CST from Monday - Friday including the flexibility to work occasional overtime based on business need

Preferred Qualifications:

• Experience with Tribal providers (ITU)
• Speak one OR more Native American languages
• Time management, organizational, and prioritization skills and ability to balance multiple priorities
• Experience in Provider demographic loads

Telecommuting Requirements:

• Reside within New Mexico
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.