Provider Relations Advocate

Optum; La Crosse (WI); Remote; USD 33,000 - 59,000; Full time

Job summary

Optum is a national health services company focused on improving health outcomes through data, care and technology. As a Provider Relations Advocate, you will maintain relationships with network providers, respond to inquiries, educate on contract expectations, and help resolve claims and service issues.

This remote nationwide role offers a scheduled 40-hour work week, Monday–Friday, with opportunities to travel as needed and to work from any U.S. location.

Qualifications

• High School Diploma/GED required.
• 1+ years of provider relations experience is required.
• Experience in the healthcare or insurance industry preferred.

Responsibilities

• Assess and resolve provider concerns and implement solutions beneficial to providers and customers.
• Educate providers on fee structures and contract expectations.
• Staff Provider Relations telephone queue and respond to calls appropriately.
• Address customer satisfaction surveys and complaints within required timeframes.
• Maintain provider compliance documents and active status in the network.
• Coordinate meetings with providers, including JOC meetings, and travel as needed.
• Assist in end-to-end provider claims processing and resolution as required.

Skills

Communication

Time management

Multitasking

Education

High School Diploma/GED

Tools

Microsoft Office

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale.

Join us to start Caring. Connecting. Growing together.

At Optum, the mission is clear: Help people live healthier lives and help make the health system work better for everyone.

Optum Serve Health Services (OSHS) is one of three businesses under Optum Serve. Optum Serve provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well-being of Americans. By joining Optum Serve you are part of the family of companies that makes UnitedHealth Group a leader across most major segments in the U.S. health care system.

OSHS specializes in creating and managing health care programs through on-location services, patient specific in-clinic appointments, telehealth assessments, or any combination based on customer need. OSHS's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

Provider Relations Advocate will maintain a successful working relationship between Optum Serve and network providers through a full range of provider relations and service interactions to ensure provider retention. Identify and remediate operational shortfalls, respond to customer complaints, customer satisfaction surveys and provider questions, and research and resolve accounts payable issues. Routinely negotiate cost effective fees for single services, confirm service capability and educate providers on contract expectations, processes and paperwork. Comprehend detailed knowledge of customer requirements in order to translate subcontractor agreements, contractual requirements and fee agreements to the providers. Provider Relations Advocate must be able to routinely evaluate and analyze the most beneficial solution for Optum Serve and our network providers in a variety of circumstances.

Schedule: A 40-hour work week, Monday through Friday, 8am - 5pm CST.

Location: Remote Nationwide

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Assess and resolve specific provider concerns, developing and implementing solutions that are beneficial to providers, LHI Customers and LHI
• Educate providers on fee structures to ensure collaborative agreement and understanding of LHI Services and the fees associated with them
• Staff Provider Relations Telephone Queue, adequately respond to and resolve incoming calls in the appropriate manner
• Respond to Customer Satisfaction Surveys and Customer Complaints within the required time frame through investigation and problem solving that results in positive outcomes
• Provide explanations and information to others on topics within area of expertise
• Proactively review and maintain provider compliance documents to ensure active status within provider network
• Collaborate with other departments to assign qualified providers to orders within the contractually allowed mileage radius of the patient's home zip code
• Assist in complex end-to-end provider claims processing and resolution, including but not limited to, claims reprocessing, modifying orders, and adhering to contractual guidelines within claim requirements
• Ability to resolve complex complaints within strict deadlines while ensuring accuracy and contractual compliance
• Assist in efforts to enhance ease of use of physician portal and future services enhancements
• Assist in identifying gaps in network composition and services to support network contracting and adequacy teams
• Utilize relevant data and facts to analyze and resolve a variety of issues within area of expertise
• Investigate and identify solutions to non-standard requests and problems, with some assistance from others
• Manage and prioritize work effectively to meet deadlines, ensuring timely responses to leadership, providers, and assigned tasks
• Provide explanations and information to others on topics within area of expertise
• Use pertinent data and facts to identify and solve a range of problems within area of expertise
• Educate providers on a wide range of topics to enhance their knowledge and compliance with policies, procedures, and best practices
• Acts as a resource for others with less experience and promotes positive work environment
• Coordinate meetings with providers to discuss a variety of topics, including JOC meetings
• Attend and contribute to multi-department meetings
• Ability to travel as needed
• Perform other duties as assigned

What Are The Reasons To Consider Working For UnitedHealth Group? Put It All Together - Competitive Base Pay, a Full And Comprehensive Benefit Program, Performance Rewards, And a Management Team Who Demonstrates Their Commitment To Your Success. Some Of Our Offerings Include

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

Required Qualifications

• High School Diploma/GED
• 1+ years of experience in provider relations
• 1+ years of computer proficiency experience with Microsoft Office (Word, Excel, and Outlook) and be able to access multiple web applications
• 1+ years of experience within the healthcare or insurance industry

Preferred Qualifications

• Knowledge of rates and managing subcontractor relationships
• Knowledge of MedNet
• Ability to effectively manage provider accounts resulting in provider retention
• Ability to develop strong professional relationships while demonstrating a clear understanding of complex business structures
• Knowledge of medical terminology

Soft Skills

• Ability to work independently and maintain good judgment and accountability
• Demonstrated ability to work well with health care providers
• Strong organizational and time management skills
• Ability to multi-task and prioritize tasks to meet all deadlines
• Ability to work well under pressure in a fast-paced environment
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others

All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $24.00 to $43.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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 - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

#RPO #GREEN