Provider Relations Representative

RXinsider LTD.; San Bernardino, Northern (CA, KY); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

Optum is seeking a Provider Relations Representative to act as the primary interface between Optum and physicians in the IPA network. The role supports operations, performance, education, training and troubleshooting for providers and staff.

The position requires regular travel across Riverside County and entails building relationships, monitoring performance, addressing issues, and collaborating with the growth team to drive membership and retention within the network.

Qualifications

• 2+ years health care/managed care experience.
• 2+ years provider relations/network experience.
• Intermediate claims processing and issue resolution.
• Proficiency with Microsoft Office Suite.
• Able and willing to travel 50% within assigned territory.

Responsibilities

• Serve as single-point-of-contact to the physician network and be an accountable owner, responsive to physician needs.
• Monitors performance of assigned PCPs and develops action plans for improvement with IPA leadership.
• Intervenes and escalates issues as appropriate.
• Maintains awareness of providers interested in new business opportunities with Optum IPA.
• Works with growth team to drive membership growth and retention.
• Responds promptly to provider issues and coordinates resolution.
• Builds collaborative relationships with IPA physicians and their staff.

Skills

Healthcare experience

Provider relations

Claims processing

Microsoft Office

Travel readiness

Tools

Microsoft Office Suite

Job description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

As a Provider Relations Representative at Optum, you will act as a direct interface between Optum and the affiliated physicians in Optum's Independent Physician Association (IPA) network and support their operations and performance success. This position provides continuous education, support, training and troubleshooting to physicians and their staff.

This position will require regular travel across Riverside County.

Primary Responsibilities

• Serve as single-point-of-contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract reimbursement, Optum's internal processes and priorities, and other Optum initiatives, as applicable
• Monitors performance of assigned PCPs, identifies low performing PCPs and works with IPA leadership to develop action plan for specific metrics needing improvement. Works with office to effectuate action plans and monitors progress
• Intervenes and escalates issues as appropriate
• Maintains awareness of providers interested in further engaging with Optum on new business opportunities (contracts and business combinations), and on shifting market/competitive dynamics that would impact the IPA
• Works collaboratively with offices and Optum growth team to drive membership growth and retention
• Responds timely (within one business day) to provider issues, works with other groups/central departments to resolve issues and updates providers and office staff regularly through to resolution
• Build collaborative relationships with IPA physicians and their office staff

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

• 2+ years of health care/managed care experience
• 2+ years of provider relations and/or provider network experience
• Intermediate level of proficiency in claims processing and issue resolution
• Proficiency with Microsoft Office Suite
• Able and willing to travel 50% within assigned territory

Preferred Qualification

• Provider recruitment and contracting experience

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 salary for this role will range from $60,200 - $90,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 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 - an enterprise priority reflected in our mission.

OptumCare 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.

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