Provider Relations Advocate

UnitedHealth Group • Denver, CO

3d • $24 - $43 • Remote

About The Position

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Optum Serve Health Services (OSHS) is one of three businesses under Optum Serve. Optum Serve provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well-being of Americans. By joining Optum Serve you are part of the family of companies that makes UnitedHealth Group a leader across most major segments in the U.S. health care system.
OSHS specializes in creating and managing health care programs through on-location services, patient specific in-clinic appointments, telehealth assessments, or any combination based on customer need. OSHS’s customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.
The Provider Relations Advocate will maintain a successful working relationship between Optum Serve and network providers through a full range of provider relations and service interactions to ensure provider retention. Identify and remediate operational shortfalls, respond to customer complaints, customer satisfaction surveys and provide questions, and research and resolve accounts payable issues. Routinely negotiate cost effective fees for single services, confirm service capability and educate providers on contract expectations, processes and paperwork. Comprehend detailed knowledge of customer requirements to translate subcontractor agreements, contractual requirements and fee agreements to the providers. The Provider Relations Advocate must be able to evaluate and analyze the most beneficial solution for Optum Serve and our network providers in a variety of circumstances.
Schedule: A 40-hour work week, Monday through Friday, a flexible schedule to be determined by the supervisor upon hire in 8-hour shifts.
Location: Remote Nationwide
You will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Requirements

• High School Diploma/GED (or higher)
• 1+ years of experience in provider relations
• 1+ years of computer proficiency experience with Microsoft Office (Word, Excel, and Outlook) and the ability to access multiple web applications
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
• Ability to work an 8-hour shift between 8:00 am - 6:00 pm Monday through Friday based upon business needs
• Ability to travel 10%25 of the time within 100 miles of territory assigned
• Access to reliable transportation with a current and non-restricted state driver’s license and state-required insurance

Nice To Haves

• Knowledge of negotiating rates and managing subcontractor relationships
• Knowledge of MedNet
• Ability to effectively manage provider accounts resulting in provider retention
• Ability to develop strong professional relationships while demonstrating a clear understanding of complex business structures
• Knowledge of medical terminology
• Ability to work independently and maintain good judgment and accountability
• Demonstrated ability to work well with health care providers
• Strong organizational and time management skills
• Ability to multi-task and prioritize tasks to meet all deadlines
• Ability to work well under pressure in a fast-paced environment
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others

Responsibilities

• Assess and resolve specific provider concerns, developing and implementing solutions that are beneficial to providers, LHI Customers and LHI
• Negotiate fees that align provider needs and LHI business objectives. Educate providers on fee structures to ensure collaborative agreement and understanding of LHI Services and the fees associated with them
• Staff Provider Relations Telephone Queue, adequately respond to and resolve incoming calls in the appropriate manner
• Respond to Customer Satisfaction Surveys and Customer Complaints within the required time frame through investigation and problem solving that results in positive outcomes
• Provide explanations and information to others on topics within area of expertise
• Proactively review and maintain provider compliance documents to ensure active status within provider network
• Collaborate with other departments to assign qualified providers to orders within the contractually allowed mileage radius of the patient's home zip code
• Assist in complex end-to-end provider claims processing and resolution, including but not limited to, claims reprocessing, modifying orders, and adhering to contractual guidelines within claim requirements
• Ability to resolve complex complaints within strict deadlines while ensuring accuracy and contractual compliance
• Assist in efforts to enhance ease of use of physician portal and future services enhancements
• Assist in identifying gaps in network composition and services to support network contracting and adequacy teams
• Utilize relevant data and facts to analyze and resolve a variety of issues within area of expertise
• Investigate and identify solutions to non-standard requests and problems, with some assistance from others
• Manage and prioritize work effectively to meet deadlines, ensuring timely responses to leadership, providers, and assigned tasks
• Provide explanations and information to others on topics within area of expertise
• Use pertinent data and facts to identify and solve a range of problems within area of expertise
• Educate providers on a wide range of topics to enhance their knowledge and compliance with policies, procedures, and best practices
• Acts as a resource for others with less experience and promotes positive work environment
• Coordinate meetings with providers to discuss a variety of topics, including JOC meetings
• Attend and contribute to multi-department meetings
• Ability to travel during business hours as needed
• Perform other duties as assigned

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and 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 (pet insurance, legal insurance, LTC Insurance, etc.)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED