Sr. Provider Engagement Specialist - Roanoke, VA

UnitedHealth Group•Roanoke, VA

1d•Remote

About The Position

This position functions as a subject matter expert in Client Service operations. This position strives to bring consistency and experience to existing Provider Engagement Specialists in the local market by analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. This position will organize and assist assigned provider groups and/or financial pools, as well as fellow account managers, in achieving short and long term operational/strategic business goals/ by developing, enhancing and maintaining operational information and models. They also develop and implement, in conjunction with the local Client Services Associate Director and/or Director, effective/strategic business solutions through research and analysis of data and business processes. The Senior Provider Engagement Specialist will develop and sustain a solid day-to-day relationship with stakeholders, the providers, and office staff to effectively implement business solutions developed by the Optum leadership team. The Senior Provider Engagement Specialist is accountable for overall performance and profitability for their assigned provider groups and/or financial pools.

Requirements

5+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, provider relations or in medical practice)
Experience with Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
Experience developing long-term positive working relationships
Experience communicating and facilitating strategic meetings with groups of all sizes
Experience working independently, using good judgment and decision-making
Experience conducting performance evaluations to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals
Experience resolving complete problems and evaluating options to implement solutions
Knowledge of state and federal laws relating to Medicare
Proficiency in Microsoft Word, Excel and PowerPoint
Reliable transportation and ability and willingness to travel, both locally in assigned territory and non-locally, as determined by business need up to 70%25
Permanent residence within a commutable distance to Roanoke, VA
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Candidates are required to pass a drug test before beginning employment.

Nice To Haves

3+ years of healthcare management experience
Experience acting as a mentor to others
Client Management experience

Responsibilities

Analyze risk pool and/or provider group performance to determine areas of focus or improvement opportunities, to include performing analysis of financial statements and other metric-related report to determine areas of focus or improvement opportunities
Develops strategies and create action plans that align provider pools and groups with company initiatives, goals (revenue and expense) and quality outcomes
Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
Use and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
Collaborates with internal clinical services teams, alongside Client Services leaders, to monitor utilization trends and risk pools to assist with developing strategic plans to improve performance
Assists provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
Maintains effective support services by working effectively with the Director of Client Services, Regional Medical Director, Clinical Services team, Operations and other corporate departments
Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues
Performs all other related duties as assigned
Data analysis required to support, compile and report key information
Drive processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.)
Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
Evaluate and drive processes, provider relationships and implementation plans
Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products
Collaborate with other Client Services leads to foster teamwork and build consistency throughout the market
Serves as a liaison to the health plan and all customers
Requires solid presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
Have the ability to communicate well with physicians, staff and internal departments