Senior Healthcare Provider Relations Advocate
UnitedHealth Group - Newark, DE

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The Senior 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 portal and future service enhancements, and training and development of external provider education programs.

Senior Provider Relations Advocates design and implement programs to build and nurture positive relationships between the health plan, providers, and practice managers.

Responsibilities also include directing and implementing strategies relating to the development and management of a provider network (small to mid-size personal care agencies, assisted living providers and other atypical providers), 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.

This position is responsible for managing the ongoing relations, communications and education between the Health Plan and the provider in relation to contract administration and claim/billing issues for ABD/LTC programs.

This includes:
• Establishes and maintains positive long-term provider contract relationships.

a) Establish and facilitate regular operators meetings with key providers

(Home and Community Based Services).

b) Obtains, records and disseminates updates in provider status that impact contract administration (ex-demographics).

c) Set up adhoc meetings as needed with key or other provider for specific or urgent needs.

d) Coordinates and conducts provider site visits as needed for credentialing purposes.

e) Responds to provider communication including phone, correspondence, bulletins/newsletter, etc

• Provides initial and on-going training and education.

a) Establish and maintain initial and on-going provider education (including product, reimbursement, billing requirements and claims).

b) Create and provide ongoing communications and education related to product, provider contract, billing, payment and provider demographics.

c) Serve as a resource to educate providers on appropriate CPT/HCPC/Revenue coding and claims submission.

d) Support and use of C & S provider materials including: provider manual, communication bulletins.

• F acilitates and coordinates process to ensure satisfactory problem resolution.

a) Identify, document and triage provider complaints to appropriate functional areas.

b) Act as key liaison for coordinating billing/payment problem resolution by establishing and supporting processes to resolve issues on a timely basis in conjunction with site staff and/or corporate staff.

c) Key accountability for effective response to conflict resolution to address provider issues or concerns through active listening, communication, and action planning.

d) Conducts on-site trouble shooting and investigation when necessary or requested by provider.

• Maintains and disseminates information on the provider network.

a) Maintain and document provider relations including, correspondence, meeting, provider resolution logs, trends and other as appropriate.

b) Maintain specific network directories/vendor lists and site directory

c) Key accountability for creating, maintaining and disseminating Provide Relations Key Customer List database.

d) On-going maintenance of accurate and current provider contract demographics forms and termination process.

This role will be based in the Hockessin, DE office, covering southern Delaware.

Requirements

Requirements:
  • Undergraduate degree preferred
  • 3+ years of provider relations and/or provider network experience.
  • Intermediate level of proficiency in claims processing and issue resolution.
  • 3+ years 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
UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

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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