Provider Relations Advocate

UnitedHealth Group•La Crosse, WI

2d•$24 - $43•Remote

About The Position

The Provider Relations Advocate maintains successful working relationships between Optum Serve and network providers through provider relations and service interactions, with the goal of provider retention. The role identifies and remediates operational shortfalls, responds to customer complaints, satisfaction surveys, and provider questions, and researches and resolves accounts payable issues. It routinely negotiates cost-effective fees for individual services, confirms provider service capabilities, and explains contract expectations, processes, paperwork, customer requirements, subcontractor agreements, and fee agreements to providers. The role evaluates solutions that benefit both Optum Serve and network providers. This is a remote nationwide position with a 40-hour work week, Monday through Friday, 8 a.m. to 5 p.m. The position may require travel as needed. The Provider Relations Advocate works with providers and internal departments on concerns, compliance, claims, provider assignments, network adequacy, and service improvements.

Requirements

High school diploma or GED.
At least 1 year of experience in provider relations.
At least 1 year of computer proficiency experience with Microsoft Word, Excel, and Outlook, including the ability to access multiple web applications.
At least 1 year of experience in the healthcare or insurance industry.
Access to reliable transportation and a valid U.S. driver's license.
Ability to work independently with 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 under pressure in a fast-paced environment.
Excellent verbal and written communication skills, including the ability to convey and interpret information clearly and concisely.
Telecommuters must adhere to UnitedHealth Group's Telecommuter Policy.
Candidates must pass a drug test before beginning employment.

Nice To Haves

Knowledge of rates and experience managing subcontractor relationships.
Knowledge of MedNet.
Ability to effectively manage provider accounts to support provider retention.
Ability to develop strong professional relationships and understand complex business structures.
Knowledge of medical terminology.

Responsibilities

Assess and resolve provider concerns by developing and implementing solutions beneficial to providers, LHI customers, and LHI.
Educate providers on fee structures and explain LHI services and associated fees.
Staff the Provider Relations Telephone Queue and respond to and resolve incoming calls appropriately.
Investigate and resolve customer satisfaction surveys and complaints within required time frames.
Provide explanations and information to others on topics within the role's area of expertise.
Review and maintain provider compliance documents to ensure providers remain active in the network.
Collaborate with other departments to assign qualified providers to orders within the contractually allowed mileage radius of a patient's home ZIP code.
Assist with complex end-to-end provider claims processing and resolution, including claims reprocessing, order modifications, and compliance with contractual claim requirements.
Resolve complex complaints within strict deadlines while maintaining accuracy and contractual compliance.
Assist with improvements to the physician portal and future services.
Help identify gaps in network composition and services to support network contracting and adequacy teams.
Use relevant data and facts to analyze and resolve issues within the role's area of expertise.
Investigate and identify solutions to non-standard requests and problems, with some assistance from others.
Manage and prioritize work to meet deadlines and provide timely responses to leadership and providers.
Educate providers on policies, procedures, and best practices to enhance their knowledge and compliance.
Act as a resource for less experienced colleagues and promote a positive work environment.
Coordinate provider meetings on a variety of topics, including JOC meetings.
Attend and contribute to multi-department meetings.
Travel as needed.
Perform other duties as assigned.

Benefits

Paid time off accruing from the first pay period.
Eight 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.