Provider Relations Advocate - Remote in Idaho

UnitedHealth Group•Boise, ID

8d•$60,200 - $107,400•Remote

About The Position

UnitedHealth Group is a health care and well-being company dedicated to improving health outcomes globally. It comprises UnitedHealthcare and Optum, working towards a better health system for all. This role is crucial in transforming healthcare. The Provider Relations Advocate is responsible for managing end-to-end HCBS provider claims, facilitating the use of the UnitedHealthcare Link Self-Help tool, and developing external provider education programs. They design and implement programs to foster positive relationships between the health plan and various providers, including Home and Community Base Services Providers, Health Homes, State Designated Entities, and other atypical service providers. This role also involves directing strategies for the development and management of a HCBS provider network, identifying network gaps, assisting with network contracting and adequacy, remediating operational shortfalls, and resolving claims issues.

Requirements

Bachelor’s degree OR 3+ years of equivalent experience
3+ years of provider relations and/or provider network experience, preferably HCBS
3+ years of experience with healthcare and managed care / health plans
3+ years of experience with Medicare and Medicaid guidelines
Intermediate level of proficiency in issue resolution
Intermediate level of proficiency with MS Word and Excel
Willing or ability to travel 25%
Resident of Idaho

Nice To Haves

Proven exceptional presentation, written and verbal communication skills
Demonstrated ability to work independently and remain on task
Demonstrated ability to prioritize and meet deadlines from multi-staff members within the department
Proven good organization and planning skills
Understanding of the provider data lifecycle (provider contracting, provider data load, provider directory, etc.)

Responsibilities

Serve as the primary contact for the health plan to contracted and non-contracted HCBS providers to resolve all provider servicing issues including claims, authorization, copies of executed contracts, and provider communications such as notices for Wage Parity and Minimum Wage compliance.
Act as the main point of contact for providers, strategically building relationships to resolve claims, prior authorization, and contract-related issues by managing a portfolio of HCBS provider accounts.
Work closely with claims Subject Matter Experts (SME) like the FAST and CPM team to complete sample audits of claims, identify root cause issues, and address related questions.
Regularly review open items and issues, maintaining a tracking document to ensure timely and accurate resolution.
Communicate resolutions to providers within 48 hours of receiving notification.
Monitor the Provider Advocate mailbox daily and answer questions related to claims and other inquiries submitted by HCBS Providers for all atypical services managed by the health plan.
Escalate appropriate issue trends to the Network Director for immediate resolution to reduce regulatory complaint filings by providers.
Use pertinent data and facts to identify and solve a range of problems within the area of expertise.
Work closely with the LTSS team around prior authorization issues for all HCBS providers to ensure full payment for billed services.
Work closely with the Clinical Practice Consultants to resolve gaps identified by providers that impact provider network agreements, provider satisfaction, and provider burden.
Collaborate with the manager to resolve gaps identified by providers with the Provider Call Center to ensure provider claims questions are appropriately reviewed and addressed.
Demonstrate a high level of autonomy by prioritizing and organizing work to meet deliverable deadlines.
Provide explanations and information to others on topics within the area of expertise.
Perform outreach and education to providers on policies and procedures to maximize the mutual benefit of a contractual relationship.
Work in partnership with the credentialing team to upload and review credentialing applications for new providers.
Work in partnership with the national contracting team regarding any inquiries or delays with contract execution.