UH
Requisition number: 2370125
Job category: Network Management
UnitedHealth Group is a health care and well-being company that's dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum , working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together.
The Provider Relations Advocate is responsible for working on end-to-end HCBS provider claims, ease of referral to Providers to use UnitedHealthcare Link Self Help tool, training and development of external provider education programs. HCBS Provider Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (Home and Community Base services Providers, Health Homes, State Designated Entity and other atypical service providers). Responsibilities also include directing and implementing strategies relating to the development and management of a HCBS provider network, identifying gaps in network composition and services to assist the network contracting, network adequacy and in identifying and remediating operational short-falls and researching and remediating claims.
Primary Responsibilities:
Serve as the primary contact for the health plan to our contracted and non-contracted HCBS providers managed by the health plan to resolve all provider servicing issues including claims, authorization, copies of executed contracts, provider communication such as notices for Wage Parity, Minimum Wage compliance
Serve as main point of contact for providers and strategically build relationships to resolve claims, prior and contract related issues managing a portfolio of accounts of HCBS providers to ensure a trusting relationship are developed and issues related to claims, prior authorization, and any other issues identified by the Providers or our internal leaders
Work closely with our claims Subject Matter Experts (SME) like the FAST and CPM team to complete sample audit of claims to identify root cause issues and address any related questions
Regularly review open items and issues, maintaining a tracking document to ensure timely and accurate resolution
Communicate resolution to the providers within 48 hours of receiving the notification
Monitor the Provider Advocate mailbox daily and serve as the main point of contact to answer questions related to claims and other inquiries submitted by the HCBS Providers for all atypical services managed by the health plan
Escalate appropriate issue trends to the Network Director for immediate resolution to reduce regulatory complaint filing by providers
Use pertinent data and facts to identify and solve a range of problems within area of expertise
Work closely with the LTSS team around prior authorization issues for all HCBS providers to ensure full payment for billed services are rendered
Work closely with the Clinical Practice Consultants to resolve gaps identified by providers which impact on provider network agreements, provider satisfaction and provider burden
Work with manager to resolve gaps identified by providers with Provider Call center to ensure provider claims questions are being appropriately reviewed and addressed
Demonstrate a high level of autonomy by prioritizing and organizing your own work to meet deliverables deadlines
Provide explanations and information to others on topics within area of expertise
Perform outreach and education to providers on policies and procedures to maximize the mutual benefit of a contractual relationship
Work in partnership with the credentialing team to upload and review credentialing applications for new providers
Work in partnership with the national contracting team regarding any inquiries or delays with contract execution
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Bachelor's degree OR 3+ years of equivalent experience
3+ years of provider relations and/or provider network experience, preferably HCBS
3+ years of experience with healthcare and managed care / health plans
Intermediate level of proficiency in issue resolution
Intermediate knowledge of Medicare and Medicaid guidelines
Intermediate level of proficiency with MS Word and Excel
Willing or ability to travel 25%
Resident of Idaho
Preferred Qualifications:
Proven exceptional presentation, written and verbal communication skills
Demonstrated ability to work independently and remain on task
Demonstrated ability to prioritize and meet deadlines from multi-staff members within the department
Proven good organization and planning skills
Understanding of the provider data lifecycle (provider contracting, provider data load, provider directory, etc.)
*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 $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
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