Healthcare Provider Relations Advocate - TRICARE
UnitedHealth Group - Sioux Falls, SD

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The Provider Relations Advocate is responsible for the full range of provider relations and service interactions within UnitedHealth Group, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training and development of external provider education programs. Provider Relations Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Responsibilities also include directing and implementing strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims. In this role you will be expected to:

- Use pertinent data and facts to identify and solve a range of problems within area of expertise.
- Investigate non-standard requests and problems, with some assistance from others.
- Work exclusively within a specific knowledge area.
- Prioritize and organize own work to meet deadlines.
- Provide explanations and information to others on topics within area of expertise.

Positions in this function are accountable for the full range of provider relations and service interactions within UHG, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs. May also be involved in identifying and remediating operational short-falls and researching and remediating claims.
- Analyzes and investigates.
- Provides explanations and interpretations within area of expertise.
- Field-based; Frequent on-site visits and meetings with physician groups or hospital systems. Smaller practices, lower spend & less complexity

Requirements:
- Undergraduate degree preferred.
- 2+ years of provider relations and/or provider network experience.
- Intermediate level of proficiency in claims processing and issue resolution.
- 1+ year of experience with Medicare and Medicaid regulations.
- Exceptional presentation, written and verbal communication skills.
- Ability to work independently and remain on task.
- Good organization and planning skills.
- Ability to prioritize and meet deadlines from multi-staff members within the department.
- Intermediate level of proficiency with MS Word, Excel, PowerPoint and Access.
- Fimiliarity with Tricare is preferred.

UnitedHealthcare Military & Veterans is part of the family of companies that make UnitedHealth Group one of the leaders across the US health care system.

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Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

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