Senior Provider Relations Advocate - Miami, FL - Bilingual Spanish Required

UnitedHealth Group•Plantation, FL

6d•$72,800 - $130,000•Hybrid

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. Position Overview The C&S Long Term Care Division requires this position for servicing the LTC provider network, to include provider contracting, credentialing and re-credentialing, conducting provider relations tasks, providing education, working in the provider portal and EVV (electronic visit verification), providing assistance with claims, ensuring network adequacy and closing gaps where necessary, along with network tracking and reporting. This associate works with the case management staff to assist with network needs for member benefits and services, to include working SCAs and PNRs (Single Case Agreements and Provider Network Requests). The Sr Provider Relations Advocate services in the capacity of Network Account Manager for managing the Florida SMMC business (Medicaid/Long-Term Care). SR PRAs develop and maintains the provider network (ancillary groups and home and community based service providers), yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management and produces an affordable and predictable product for customers and business partners. SR PRAs evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining solid business relationships with providers, and ensuring the network composition includes an appropriate distribution of Long-Term Care (LTC), Home & Community Based (HCBS)specialties. Additional Job Information: This position will be located in Florida. The goals of our LTC network team are to manage and carry out the provider network requirements for the Health Plan with the State regulator. Provider Relations, Network and Contracting experience is a must, Microsoft Excel intermediate to advanced level is required due to the needs of network reporting. Microsoft Access basics is a plus. Prefer candidate to have Associate Degree or higher. Experience with provider credentialing applications, contracting and fee tables, claims knowledge, Spanish bilingual is preferred. If you live in FL, you will have the flexibility to work remotely as you take on some tough challenges. This position requires 25 - 50%25 travel in Miami region.

Requirements

5+ years working in a network management-related role, such as contracting or provider services
3+ years of experience in ancillary/facility/group credentialing, to include knowledge of credentialing requirements for the State of Florida
3+ years working with provider/group Medicaid/Long Term Care contracts, claims, credentialing
3+ years of experience in performing network adequacy analysis
Intermediate level of knowledge of Medicaid and Long Term Care reimbursement methodologies
Intermediate level in Microsoft Word, Excel, PowerPoint, Access
Proven ability to work in a fast-pace ever-changing environment
Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others
Proven solid interpersonal skills, establishing rapport and working well with others
Proven solid customer service skills
Driver’s License and access to a reliable transportation
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Nice To Haves

Microsoft Access basics is a plus
Associate Degree or higher
Experience with provider credentialing applications, contracting and fee tables, claims knowledge
Spanish bilingual is preferred

Responsibilities

Servicing the LTC provider network, to include provider contracting, credentialing and re-credentialing, conducting provider relations tasks, providing education, working in the provider portal and EVV (electronic visit verification), providing assistance with claims, ensuring network adequacy and closing gaps where necessary, along with network tracking and reporting.
Works with the case management staff to assist with network needs for member benefits and services, to include working SCAs and PNRs (Single Case Agreements and Provider Network Requests).
Services in the capacity of Network Account Manager for managing the Florida SMMC business (Medicaid/Long-Term Care).
Develops and maintains the provider network (ancillary groups and home and community based service providers), yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management and produces an affordable and predictable product for customers and business partners.
Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.
Establishes and maintains solid business relationships with providers, and ensuring the network composition includes an appropriate distribution of Long-Term Care (LTC), Home & Community Based (HCBS)specialties.
Apply basic knowledge of provider network functions, ability to work in a fast-paced environment
Ability to take initiative and use problem-solving skills for issue resolution
Must be attentive to detail, work with flexibility, and have the capability of multi-tasking to meet deadlines and deliverables
Possess knowledge in Medicaid and Long Term Care (Home and Community Based) programs
Must have good communication skills; and the ability to build and retain relationships with Provider/Ancillary providers
Experience working with Health Plan contracts in compliance with company contract templates to ensure the network composition includes an appropriate distribution of provider specialties
Display professional work ethics in a structured work environment
Team environment aptitude, work in partnership with Sr Provider Relations Advocates and interact well with staff in cross-segment departments
Perform other duties as required