Provider Relations Advocate - Remote in Massachusetts

UnitedHealth Group•Boston, MA

14h•$60,200 - $107,400•Remote

About The Position

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs — helping patients access and navigate care anytime and anywhere. As a team member of our Senior Community Care (SCC) team, we work to provide care to patients in nursing homes, senior housing and assisted living settings. This life-changing work adds a layer of support to improve access to care. We’re connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together. The more you do, the more you learn. As you learn, you'll discover new opportunities to grow, make an impact, and bring your best every day. As a Provider Relations Advocate with UnitedHealth Group, you'll play a critical role in strengthening provider partnerships and improving the health care experience for providers and members alike. We're building solider, more effective provider networks every day. In this role, you'll serve as a trusted resource and advocate for providers, using your customer service skills, managed care knowledge, and claims expertise to help resolve issues and improve the provider experience. You'll have the opportunity to deepen your understanding of provider relations, network operations, claims processes, and health plan administration while gaining exposure to a broad range of business partners and functions across the organization. This individual contributor role is ideal for early to mid-career professionals seeking to advance their careers within provider relations and managed care. The ideal candidate brings experience working with skilled nursing facilities or long-term care providers and possesses a solid understanding of MassHealth policies, including billing, authorization, and regulatory processes. If you are located within Massachusetts, you will have the flexibility to work remotely as you take on some tough challenges.

Requirements

High school diploma/GED or equivalent experience
1+ years of experience working within a Skilled Nursing Facility (SNF), Nursing Facility, Long-Term Care (LTC), post-acute care setting, or other provider organization serving senior populations
1+ years of experience supporting provider operations, provider relations, billing, reimbursement, admissions, utilization review, authorization, care coordination, or related functions
Proven working knowledge of Massachusetts Senior Care Options (SCO) and the coordination of Medicare and MassHealth (Medicaid) benefits
Experience collaborating with facility leadership, business office staff, billing teams, clinical staff, and external stakeholders
Intermediate proficiency with Microsoft Office
Driver’s License and access to reliable transportation

Nice To Haves

3+ years of experience working within a Skilled Nursing Facility (SNF), Nursing Facility, Long-Term Care (LTC), post-acute care setting, or other provider organization serving senior populations
3+ years of experience supporting provider operations, provider relations, billing, reimbursement, admissions, utilization review, authorization, care coordination, or related functions
Experience with Medicare and Medicaid programs, including claims, billing, reimbursement, eligibility, prior authorization, and issue resolution
Solid understanding of claims adjudication, reimbursement methodologies, provider appeals, and payment resolution processes
Knowledge of provider contracting, credentialing, and network development functions
Experience analyzing provider trends and recommending operational improvements

Responsibilities

Serve as a trusted resource to skilled nursing facilities and long-term care providers, helping navigate claims, billing, authorization, and operational processes
Experience working directly in a skilled nursing facility, nursing facility, or long-term care environment and possess a solid understanding of Massachusetts Senior Care Options (SCO), including Medicare and MassHealth (Medicaid) policies and regulations
Experience with facility billing, prior authorization workflows, claims management, reimbursement processes, and nursing facility regulations is highly desired
The successful candidate will understand the day-to-day operational needs of nursing facilities and be able to build solid provider relationships while supporting issue resolution and provider education initiatives