National Senior Provider Relations Advocate - Remote

UnitedHealth Group•Minnetonka, MN

15d•Remote

About The Position

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The National Ancillary and Hospital Provider Advocate role is a professional, self-directed individual who will serve as the point of contact to take in and resolve complex Operations issues the assigned Provider Account is experiencing, proactively educate on new products and programs, bring actionable data and tools to assist their organization with achieving their business goals, as well as anticipate challenges their organization might face, while also assisting with finding solutions by working across UHG's dynamic and matrixed organization for assigned UHC Strategic and Core Provider Accounts in conjunction with their Affiliates representing UHC's top revenue generating contracts. The National Ancillary and Hospital Provider Advocate will be the assigned single point of contact for the Healthcare organization representing both government and commercial products to build and improve provider satisfaction for UHC. This externally focused position will maximize the providers' ability to interact with UHC through both pre-scheduled engagements with the Healthcare organization's representative to discuss new and upcoming changes occurring within UHC that will impact their specific account, discussing the Healthcare organization's service issues, while also engaging on an ad hoc basis as the Advocate either identifies or learns of a trending issue that might impact any of their assigned accounts. The National Ancillary and Hospital Provider Advocate role is a professional, self-directed individual who will serve as the point of contact to take in and resolve complex Operations issues the assigned Provider Account is experiencing, proactively educate on new products and programs, bring actionable data and tools to assist their organization with achieving their business goals, as well as anticipate challenges their organization might face, while also assisting with finding solutions by working across UHG's dynamic and matrixed organization for assigned UHC Strategic and Core Provider Accounts in conjunction with their Affiliates representing UHC's top revenue generating contracts. The National Ancillary and Hospital Provider Advocate will be the assigned single point of contact for the Healthcare organization representing both government and commercial products to build and improve provider satisfaction for UHC. This externally focused position will maximize the providers' ability to interact with UHC through both pre-scheduled engagements with the Healthcare organization's representative to discuss new and upcoming changes occurring within UHC that will impact their specific account, discussing the Healthcare organization's service issues, while also engaging on an ad hoc basis as the Advocate either identifies or learns of a trending issue that might impact any of their assigned accounts. The National Ancillary and Hospital Provider Advocate works across the organization to better understand if any initiatives or issues might impact their assigned Provider Account, and while a pipeline of initiatives with tentative rollout timelines exists, the National Provider Advocate will have ownership of ensuring applicability of the various initiatives as it relates to their assigned Provider Accounts and have the autonomy to determine how best to engage ensuring their assigned Account has what they need to be successful. This role will develop and execute the Chart Retrieval/Chase engagement strategy with key Provider Accounts, identifying and collaborating with key stakeholders of our largest Providers. Leaning on industry knowledge, built relationships and marketing savvy, the role will educate key Provider accounts on the benefits of the Retrieval program to gain alignment and participation. In this work, the role will partner with the UHN Contracting team and OptumHealth to execute the enterprise's strategy, focusing on the risk adjustment and audit components of the Chart Retrieval/Chase work. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

3+ years of experience in health plans or provider experience, with a demonstrated focus on training, education, and/or revenue cycle work
3+ years of project management understanding with related experience
3 + years of experience in Medicare/Commercial/Medicaid products
3 + years of Provider Network Development and/or Provider Relations experience
General knowledge of CPT and ICD-10 coding
Ability to interpret provider contracts and regulatory contracts
Proven knowledge of claims processing, clinic operations, managed care plan benefits and utilization management policies and procedures
Proficiency with MS Office suite, SharePoint
Demonstrated ability to work in a fast-paced environment
Proven analytical and problem-solving skills
Demonstrated ability to communicate effectively in writing and verbally
Proven public speaking and presentation skills

Nice To Haves

Experience in Provider Billing capacity, claims level audit, recovery operations experience with claims data knowledge.
Experience with claims platforms or healthcare platforms
Experience working in a capitated/delegated or shared risk environment
Experience managing, coordinating and/or explaining complex capitated-delegated processes including cap-deductions and explanations
Ability to work within multiple complex technology and enterprise-wide systems
Ability to prioritize tasks and work independently and effectively under time constraints
Solid interpersonal skills, establishing rapport and working well with internal partners
Solid analytical, critical reasoning and organizational skills
Solid customer service skills with critical thinking skills and confidence to evaluate and develop solutions
Excellent verbal and written communication skills with the ability to communicate effectively with external providers

Responsibilities

Ability to become a trusted advisor for assigned Provider Accounts through demonstration of our Cultural Values of Integrity, Compassion, Relationships, Innovation, and Performance
National Provider Advocates must possess an inherent ability to problem-solve complex and novel issues that may not have a clear path to resolution. To be successful, the National Provider Advocate must constantly build upon their own experience and understanding of the enterprise and have a high degree of resilience and persistence to root-cause issues and see through to resolution because standard operating procedure guidelines for most issues do not exist or are limited in scope
Working across dynamic/matrixed org
Understanding assigned Provider Account's practice management system to proactively identify issues
Triage and determine root cause through researching data and claims systems for all Lines of Business for of escalated claims impacting a provider's Accounts Receivable, including capitated requirements
Work across the enterprise to design and implement solutions to identified trend issues, through reporting, improvements to processing instructions, or other innovations. Where applicable, determine broader impact of identified root cause issues beyond the provider where the topic was initiated
Communicate with and educate providers on outcomes of root cause analyses, including proposed actions for the provider to improve their revenue cycle experience, including education on billing/coding errors, reimbursement policies, etc.
Establish proactive reporting and other initiatives to identify and act on opportunities to minimize provider abrasion while solutions are being implemented.
Collaborate with assigned providers on revenue-cycle-based analyses of the provider's claims data to identify trends in billing, claim processing or other practices that are negatively impacting the provider's revenue cycle experience
Conduct live, telephonic and/or web-based meetings with providers to review findings of identified practice gaps by discussing opportunities for UHG and/or the provider to implement changes in the practice to improve the revenue cycle experience, and track progress of each agreed initiative
Conducts provide education via in-person, telephonic and/or web-based interactions, with individual providers and in group settings, such as Town Hall meetings, Joint Operating Committee meetings, Provider Information Expos or Mobile Service Center meetings. The educational topics will be relevant to how a provider can maximize their interaction with UHG and their revenue cycle experience. These topics can include, but are not limited to, the following: Training on UHCProvider.com, Link and other self-service tools for existing and new provider staff; training on UHG policies such as reimbursement policies; industry changes such as new DRGs and other codes that impact a provider's revenue cycle; and ongoing training on new products, lines of business, systematic tools such as Smart edits, etc., that are implemented within the National Provider Advocate's provider portfolio
Use appropriate tracking tools and service models to escalate service issues. Interact with UHN and other operations areas where necessary for contract intent clarification, compliance questions, etc.
Make educational outreach as needed related to request from internal areas such as lines of business contacts, appeals and grievances, etc.
Serve as liaison between the provider and other UHG areas as needed to identify solutions for perceived revenue cycle barriers, such as clinical decisions and coding accuracy audits.
Provide feedback and guidance to network management regarding administrative compatibility, performance, and opportunities for improvement in contractual agreements
Engage with enterprise business partners to identify common billing practices and educate provider to reduce office administrative burden and increase operating efficiencies.
Position requires travel to meet with providers to support all educational needs
Solid self-management skills, ability to handle rapid change and an affinity for continuous learning

Benefits

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).

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