Senior Provider Relations Representative

RXinsider LTD.; San Diego (CA); On-site; USD 72,800 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

Equity stock purchase

401k contribution

Job summary

OptumCare is seeking a Primary Liaison between the client and MSO to deliver Managed Care Administrative Services and to explain all service phases to IPA groups while addressing issues and identifying process improvements.

The role involves coordinating meetings, educating provider offices, and managing relationships with health plans, with a focus on maintaining professional communications and supporting the organization’s network strategies.

Qualifications

• 5+ years of experience in managed care
• Proven experience in managed care operations
• Experience training individuals on managed care policies and procedures in small or large groups
• Experience organizing meetings and taking minutes; ability to conduct online meetings and conference calls
• Knowledge of CPT, ICD-9 Codes
• Adept in interpreting contract language, rates, and coverage definitions
• Ability to communicate professionally, solve problems, and work independently
• Excellent organizational and interpersonal skills
• Ability to work effectively with a wide variety of people at all levels
• Reliable transportation, valid California Driver's License and proof of insurance

Responsibilities

• Coordinates and conducts meetings within assigned territory; maintains minutes, agendas and signatures
• Supports client services in resolving provider issues and training needs
• Manages interface between providers, MSO and health plans; builds relationships
• Recruits providers in geographic areas and negotiates contracts within guidelines
• Develops provider manuals, directories, and communications; facilitates distribution
• Provides updates to materials for clarity and regulatory alignment
• Portal setup, training, documentation, and vendor IT coordination
• Performs other duties and participates in cross-functional initiatives

Skills

Managed care operations

Provider relations

Project coordination

Communication

Problem solving

MSO interfacing

Tools

Microsoft Office

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.

Primary liaison between the client and MSO for the delivery of Managed Care Administrative Services. Responsible for concise and complete explanations of all phases of services from each MSO Department to the assigned IPA groups and resolving issues between them. Also responsible for identifying process improvement opportunities and supporting long-term relationship management strategies with provider groups.

Primary Responsibilities

• Coordinates and conducts meetings within assigned territory. Maintains official copies of minutes, agendas and credentialing signatures at the MSO's office. Sends announcements regarding scheduled meetings, makes phone calls to verify attendance (quorum), orders refreshments and sets up/breaks down the meetings. Prepares, or directs the preparation of, agendas, handouts and meeting minutes. Represents management at all meetings with clients in an appropriate and professional manner
• Serves as a resource for internal referrals on provider issues. Supports the Client Services Department in resolving provider issues and responds to training needs identified by other MSO departments such as Claims and Medical Management. Interfaces with Health Plan staff as required. Effectively problem solves issues as identified; documents all contact with providers/office staff in the provider's file. Monitors client needs to evaluate satisfaction levels, and identifies trends and areas requiring improvement. Identifies recurring issues and collaborates with teams to refine training content and improve cross-departmental processes
• Manages the interface between providers, the MSO and the health plans. Remains accessible to providers and their office staff. Leaves specific instructions about how to be reached within and outside the office. Utilizes email and the cell phone to maintain productivity within and outside the office. Schedules regular visits with physician offices to provide education, training and customer service. Establishes and maintains strong, productive relationships with office staff by providing superior customer service and effectively solving issues. Stays current with activities in the market by developing an open rapport with the offices. Represents management at all meetings with clients in an appropriate and professional manner. Collaborates with leadership to prioritize high- impact providers and proactively address network challenges
• Recruits providers in designated geographic areas, negotiates provider contracts within specified guidelines and assists the Director of Network Management in all phases of network negotiations and contracting. Investigates interested providers for consideration by the regional committee. Notifies health plans and appropriate internal departments of provider contract and status changes. Functions as a messenger between plans and IPA clients, as applicable, during contracting functions
• Develops provider manuals, provider directories, provider communications, and other related materials; and facilitates the distribution of such information
• Provides feedback and recommends updates to materials to ensure clarity, consistency, and alignment with regulatory changes
• Internet portal user set-up, training, documentation, communication and troubleshooting with vendors as necessary. Monitors common user issues and collaborates with IT to improve portal functionality and user experience
• Completes other duties as requested and assigned. May participate in cross- functional initiatives or special projects to support department and organizational goals

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

• 5+ years of experience in managed care
• Proven experience in managed care operations
• Experience training individuals on managed care policies and procedures in small or large groups. Presentation skills
• Experience organizing meetings and taking minutes. Ability to conduct on-line meetings and conference calls
• Knowledge of CPT, ICD-9 Codes
• Adept in interpreting contract language, rates, and coverage definitions
• Ability to communicate in a professional manner, have problem solving skills and work independently
• Excellent organizational and interpersonal skills
• Ability to work effectively with a wide variety of people at all levels
• Computer literacy, including competence with various word processing and managed care programs. Microsoft Office familiarity
• Reliable transportation, valid California Driver's License and proof of insurance

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 $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.