Provider Relations & Network Growth Specialist

Optum; McAllen (TX); On-site; USD 60,000 - 107,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options with HSA

Dental, Vision, Life & AD&D Insurance

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus Program

Voluntary Benefits

Job summary

WellMed, part of the Optum family, is seeking a Provider Relations professional in McAllen, TX. This role supports end-to-end provider claims, enhances physician portal usability, and fosters strong relationships among health plans, providers, and practice managers.

Qualifications include 4+ years in health care/managed care, 2+ years in provider relations, 1+ year in claims processing, and knowledge of Medicare/Medicaid regulations. Travel of 50-75% within the market is required.

Qualifications

• 4+ years of health care/managed care experience.
• 2+ years of provider relations and/or provider network experience.
• 1+ years of experience in claims processing and issue resolution.
• 1+ years of experience with Medicare and Medicaid regulations.
• Intermediate level of proficiency with MS Office.

Responsibilities

• Assist in end-to-end provider claims and help enhance call quality.
• Assist in efforts to enhance ease of use of physician portal and future services enhancements.
• Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers.
• Support development and management of provider networks.
• Help implement training and development of external providers through education programs.
• Identify gaps in network composition and services to assist network contracting and development teams.
• Ability to travel as needed 50 - 75% within market

Skills

Health care experience

Provider relations experience

Claims processing experience

Medicare/Medicaid regulations

MS Office proficiency

Education

Bachelor's degree in a related field

Tools

MS Office Suite

Job description

WellMed, part of the Optum family, is seeking a Provider Relations professional in McAllen, TX. This role supports end-to-end provider claims, enhances physician portal usability, and fosters strong relationships among health plans, providers, and practice managers.

Qualifications include 4+ years in health care/managed care, 2+ years in provider relations, 1+ year in claims processing, and knowledge of Medicare/Medicaid regulations. Travel of 50-75% within the market is required.