Provider Relations Advocate
About The Position
The Provider Relations Advocate maintains successful working relationships between Optum Serve and network providers through provider relations and service interactions to support provider retention. The role identifies and addresses operational shortfalls; responds to complaints, satisfaction surveys, and provider questions; researches and resolves accounts payable issues; and negotiates cost-effective fees for single services. The Advocate confirms service capabilities and educates providers about contract expectations, processes, paperwork, fee structures, and customer requirements. The role interprets subcontractor agreements, contractual requirements, and fee agreements for providers, and evaluates solutions that benefit Optum Serve and network providers. This is a remote position available nationwide, with a 40-hour Monday–Friday work week in 8-hour shifts. The schedule is flexible within business needs and is determined by the supervisor upon hire. Travel may be required, including travel within the assigned territory. Optum Serve Health Services creates and manages health care programs using on-location services, patient-specific in-clinic appointments, telehealth assessments, or combinations tailored to customer needs. Its customizable solutions serve commercial customers and federal and state agencies.
Requirements
- High school diploma or GED.
- At least 1 year of provider relations experience.
- At least 1 year of computer proficiency using Microsoft Office (Word, Excel, and Outlook) and 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 existing high-speed internet service.
- Ability to work an 8-hour shift between 8:00 a.m. and 6:00 p.m., Monday through Friday, based on business needs.
- Reliable transportation, a current unrestricted state driver’s license, and state-required insurance; ability to travel 10% of the time within 100 miles of the assigned territory.
- Ability to work independently while maintaining sound judgment and accountability.
- Ability to work effectively 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 to understand and interpret information from others.
- Adherence to UnitedHealth Group’s Telecommuter Policy.
- 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.
- Knowledge of medical terminology.
Responsibilities
- Assess and resolve provider concerns by developing and implementing solutions beneficial to providers, customers, and LHI.
- Educate providers about fee structures, LHI services, policies, procedures, best practices, and compliance expectations.
- Staff the Provider Relations Telephone Queue and appropriately respond to and resolve incoming calls.
- Investigate and respond to customer satisfaction surveys and complaints within required time frames.
- 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 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 accurately, within strict deadlines, and in compliance with contracts.
- Help improve the physician portal and future service offerings.
- Identify network composition and service gaps to support network contracting and adequacy teams.
- Use relevant data and facts to analyze and resolve issues, including non-standard requests and problems, sometimes with assistance.
- 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 participate in multi-department meetings.
- Travel as needed.
- Perform other duties as assigned.
Benefits
- Paid time off accrued beginning with the first pay period and 8 paid holidays.
- Medical plan options and participation in a Health Spending Account or Health Savings Account.
- Dental, vision, life and AD&D insurance, and short- 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, including pet insurance, legal insurance, and long-term care insurance.
- Comprehensive benefits package, incentive and recognition programs, and 401(k) contribution, subject to eligibility requirements.
- Performance rewards and opportunities for development into other roles.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
