Provider Relations Advocate

UnitedHealth Group • La Crosse, WI

3d • $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 that support provider retention. The role identifies and remediates operational shortfalls; responds to complaints, satisfaction surveys, and provider questions; researches and resolves accounts payable issues; negotiates cost-effective fees for single services; confirms service capabilities; and educates providers about contract expectations, processes, paperwork, fees, policies, procedures, and best practices. The advocate interprets customer requirements, subcontractor agreements, contractual requirements, and fee agreements for providers, and evaluates solutions that benefit Optum Serve and its network providers.

This is a remote position available nationwide, with a 40-hour work week from Monday through Friday. The employee works an eight-hour shift scheduled by the supervisor, between 8:00 a.m. and 6:00 p.m. based on business needs. The role requires a designated, quiet home workspace that can secure Protected Health Information and access to approved high-speed internet. Travel may be required. The position offers an hourly pay range of $24 to $43, based on factors including labor market, education, experience, and certifications.

Requirements

• High school diploma or GED.
• At least 1 year of experience in provider relations.
• At least 1 year of computer proficiency using Microsoft Word, Excel, and Outlook, with the ability to access multiple web applications.
• Access to a designated quiet workspace at home, separate from non-work 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 have access to existing high-speed internet service.
• Ability to work an eight-hour shift between 8:00 a.m. and 6:00 p.m., Monday through Friday, based on business needs.
• Ability to work independently while maintaining good judgment and accountability.
• Demonstrated ability to work well with health care providers.
• Strong organizational and time-management skills, including the ability to multitask and prioritize to meet deadlines.
• Ability to work under pressure in a fast-paced environment.
• Excellent verbal and written communication skills, including the ability to communicate clearly and concisely and understand and interpret information from others.
• Adherence to UnitedHealth Group’s Telecommuter Policy.
• Candidates must pass a drug test before beginning employment.

Nice To Haves

• Knowledge of rates and subcontractor relationship management.
• Knowledge of MedNet.
• Ability to manage provider accounts effectively and support provider retention.
• Ability to develop strong professional relationships and understand complex business structures.
• Ability to travel 10%–25% of the time within 100 miles of the assigned territory, with reliable transportation, a current unrestricted state driver’s license, and state-required insurance.
• Knowledge of medical terminology.

Responsibilities

• Assess and resolve provider concerns by developing and implementing solutions beneficial to providers, LHI customers, and LHI.
• Educate providers about fee structures, LHI services, associated fees, policies, procedures, and best practices.
• Staff the Provider Relations Telephone Queue and respond to and resolve incoming calls appropriately.
• Investigate and respond to customer satisfaction surveys and complaints within required time frames, aiming for positive outcomes.
• Provide explanations and information to others on topics within the role’s area of expertise.
• Proactively review and maintain provider compliance documents to support active network status.
• Collaborate with other departments to assign qualified providers to orders within contractually permitted mileage of the patient’s home ZIP code.
• Assist with complex end-to-end provider claims processing and resolution, including claims reprocessing and order modifications, while following contractual guidelines and claim requirements.
• Resolve complex complaints within strict deadlines while ensuring accuracy and contractual compliance.
• Assist with improvements to the physician portal and future service enhancements.
• Identify network composition and service gaps to support network contracting and adequacy teams.
• Use relevant data and facts to analyze and resolve issues and investigate 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.
• Act as a resource for less-experienced colleagues and promote a positive work environment.
• Coordinate provider meetings, including JOC meetings, and attend and contribute to multi-department meetings.
• Travel as needed.
• Perform other duties as assigned.

Benefits

• Paid time off accrued beginning with the first pay period and eight paid holidays.
• Medical plan options and participation in a Health Spending Account or Health Savings Account.
• Dental insurance.
• Vision insurance.
• Life and AD&D insurance.
• Short-term disability coverage.
• Long-term disability coverage.
• 401(k) savings plan and 401(k) contribution.
• 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.
• Comprehensive benefits package, subject to eligibility requirements.

What This Job Offers

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