UH
Requisition number: 2370244
Job category: Network Management
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 .
As a Senior Provider Relations Advocate, you will play a crucial role in supporting providers such as Aging Service Access Points (ASAPs) and Home and Community Based Providers (HCBS) within the Massachusetts market. You will focus on the Senior Care Option and One Care lines of business for UnitedHealthcare Community and State. This position requires a deep understanding of provider relations, healthcare regulations, and the ability to foster positive relationships with providers to ensure optimal service delivery and satisfaction.
There are changes happening in health care that go beyond the basics we hear in the news. People like you and organizations like UnitedHealth Group are driving ever higher levels of sophistication in how provider networks are formed and operate. The goal is to improve quality of service while exploring new ways to manage costs. Here's where you come in. You'll use your solid customer service orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. As you do, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 5 leader.
If you are located within Massachusetts, Rhode Island, or New Hampshire, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Demonstrate a thorough understanding of policies and procedures impacting providers, including claims, appeals, complaints, benefits, regulatory requirements, and client business needs
Develop and maintain solid relationships with ASAPs, HCBS, and Community Based Organizations (CBOs) Serve as the primary liaison to providers, ensuring positive, productive, and informative interactions
Assist providers with claims issues, enhance the use of UHC's provider portal, and troubleshoot inquiries to ensure optimal performance
Work collaboratively with Clinical, Sales, and other health plan and national departments to resolve issues and improve provider/customer satisfaction and growth
Review provider contracts and audit systems for correct contract configuration
Implement training and development programs for external providers through education initiatives by resolving provider claims issues, enhancing the use of UHC's provider portal, and troubleshoot provider inquiries for optimal performance
Provide coaching, feedback, and guidance to team members to foster professional growth and improve performance
Facilitate and lead quarterly Joint Operation Committee (JOC) meetings with select providers and their leadership teams
Contribute to efforts to enhance the ease of use of the UHC provider portal and future service enhancements
Design and implement programs that build and nurture positive relationships between the health plan, providers, and practice managers
Identify gaps in network composition and services to assist network contracting and development teams
In this role, you'll be part of a performance driven, fast paced organization that is serving multiple markets. You'll have frequent interactions with senior management and physicians as you communicate about ways to evolve ongoing processes and programs.
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
2+ years of experience in a managed care organization, network management, healthcare operations or provider relations related role, such as contracting or provider services
2+ years of provider relations and/or provider network experience
Intermediate proficiency in MS Word, Excel, and PowerPoint
Ability to travel approximately 25% within Massachusetts
Driver's License and access to a reliable transportation
Preferred Qualifications:
2+ years of experience with Medicare and Medicaid regulations
Experience with systems such as CSP Facets, NDB, and EDI processes
Soft Skills:
Proven excellent organizational, planning, prioritizing, and multi-tasking skills
Proven exceptional presentation, written, and verbal communication skills
Proven ability to manage multiple tasks and projects simultaneously
Proven ability to work independently, in a team and cross-functionally (i.e., Clinical, Sales, Operations)
*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 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.
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.
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