National Provider Relations Advocate

UnitedHealth Group•La Crosse, WI

2d•$24 - $43•Remote

About The Position

Optum Serve Health Services (OSHS), part of Optum Serve, creates and manages health care programs for commercial customers and federal and state agencies. The National Provider Relations Advocate manages provider relations and service interactions, including provider claims and concerns, provider portal usability, and support for external provider education and training. The role fosters positive relationships among Optum Serve, providers, and program managers and supports provider-network retention. It may also involve identifying and remediating operational shortcomings and researching and resolving claims. This is a remote, nationwide position with a 40-hour work week, Monday through Friday, working eight-hour shifts. The schedule is flexible as determined by the supervisor upon hire. The role includes travel to sites to ensure compliance; the posting describes this as “10%25” and also mentions visits 50 to 100 miles from home. The advocate onboards and educates providers, communicates provider needs to internal stakeholders, investigates and resolves issues, supports provider recruitment and retention, maintains provider information, and helps providers understand performance under incentive contracts and accountable-care strategies. The role also involves collecting and analyzing data, coordinating solutions, and ensuring provider data accuracy and timely responses to complaints. UnitedHealth Group describes its mission as helping people live healthier lives and making the health system work better for everyone. It states a commitment to mitigating its environmental impact and delivering equitable care that addresses health disparities and improves health outcomes.

Requirements

High school diploma.
At least 1 year of experience in provider relations.
At least 1 year of customer service or health care experience.
Intermediate computer proficiency with Microsoft Word, Excel, and Outlook, and ability to access multiple web applications.
Access to a designated quiet workspace at home, separated from non-work areas, with the ability to secure Protected Health Information (PHI).
Live in a location that can receive a UnitedHealth Group-approved high-speed internet connection or have existing high-speed internet service.
Adhere to UnitedHealth Group’s Telecommuter Policy.
Ability to work independently and demonstrate good judgment and accountability.
Demonstrated ability to work well with health care providers.
Strong organizational and time-management skills.
Ability to multitask and prioritize tasks to meet deadlines.
Ability to work well under pressure in a fast-paced environment.
Ability to solve complex problems.
Ability to collaborate with internal and external teams and providers.
Excellent verbal and written communication skills, including the ability to convey information clearly and concisely and understand and interpret information from others.

Nice To Haves

Ability to travel within the assigned territory; the posting describes travel as “10%25” and within 100 miles of the territory assigned.
Reliable transportation, a current and unrestricted state driver’s license, and state-required insurance.
Provider data loading or other health care database maintenance experience.
Proficiency with MS Access, MS Visio, and/or MS SharePoint.
Experience in continuous process, efficiency, and quality improvement.
At least 2 years of data-entry experience.

Responsibilities

Provide onboarding and orientation to new providers, including online training and instruction on network participation processes.
Participate in company initiatives related to compliance or advocating company resources.
Apply knowledge of health care industry practices, trends, and issues to communicate how products and services can benefit providers.
Communicate and advocate providers’ needs to internal stakeholders to develop solutions that meet mutual business goals.
Develop resources and programs to assist and educate providers, such as web-based training and FAQ documents.
Work with internal groups to identify, understand, and improve tools, resources, systems, and capabilities that can improve provider, member, or company performance.
Assess providers’ understanding and needs related to industry and company information, tools, systems, and changes.
Communicate industry and company information to providers through newsletters, emails, outreach calls, teleconferences, conferences, and on-site meetings.
Provide providers with feedback on quality and performance metrics or scorecards.
Educate providers on policies and procedures related to care delivery, including regulatory, benefit, and claims topics.
Educate providers on administrative tools, including portals, electronic payments and statements, Intellijet, and IVR.
Educate providers on clinical tools, processes, and programs, including utilization review, wellness assessments, quality and gaps in care, Premium Designation, View360, and UM Template.
Gather data from relevant systems and business partners, including claims, data warehouses, payment integrity, EDI/Portal reporting, customer relations systems, contracting, and claims operations.
Collaborate with colleagues to identify potential root causes of issues.
Understand providers’ business goals and strategies to facilitate analysis and resolution of their issues.
Analyze data to determine root causes, identify trends, patterns, outliers, and anomalies, and escalate issues for further analysis when necessary.
Involve leadership or escalate issues as necessary to implement provider solutions.
Coordinate with internal and external resources to implement provider solutions.
Ensure solutions meet provider needs and improve provider satisfaction, including by simplifying processes.
Analyze network adequacy against access standards, target markets, or customer requirements to identify provider-recruitment needs.
Conduct network analysis to identify provider recruitment opportunities, including reviewing competitive data and Board Certified website information.
Research provider nominations or recruitment requests from members, sales, or account management to support network adequacy.
Summarize and communicate provider-network recruitment or retention outcomes to internal and external stakeholders.
Build and sustain effective provider relationships, maintain open communication, and stay aware of provider needs.
Update provider information, including addresses, locations, and specialties.
Support provider recruitment and retention by identifying or implementing opportunities to improve or expand provider services.
Respond to provider requests by directing providers to appropriate internal or external resources.
Help providers understand and improve performance under incentive contracts and accountable-care strategies.
Communicate provider updates and information to relevant stakeholders regarding research and resolution of issues within defined metrics, such as turnaround time.
Ensure provider data, including demographics and fee schedules, is accurate through audits, re-credentialing, or outreach.
Review and respond to provider complaints in a timely manner.
Perform other duties as assigned.

Benefits

Paid time off accrued beginning with the first pay period.
8 paid holidays.
Medical plan options.
Health Spending Account or Health Savings Account participation.
Dental insurance.
Vision insurance.
Life and AD&D insurance.
Short-term disability coverage.
Long-term disability coverage.
401(k) savings plan.
Employee Stock Purchase Plan.
Education reimbursement.
Employee discounts.
Employee Assistance Program.
Employee Referral Bonus Program.
Voluntary benefits, including pet insurance, legal insurance, and long-term care insurance.
Performance rewards and incentive and recognition programs.
Equity stock purchase and 401(k) contribution, subject to eligibility requirements.
Comprehensive benefits package, subject to eligibility requirements.