Provider Relations Representative

UnitedHealth Group•San Diego, CA

5d•$60,200 - $107,400•Onsite

About The Position

Primary liaison between the client and MSO for the delivery of Managed Care Administrative Services. Responsible for concise and complete explanations of all phases of services from each MSO Department to the assigned IPA groups and resolving issues between them.

Requirements

2+ years of experience in managed care operations and/or a clinical/office setting
Experience training individuals on managed care policies and procedures in small or large groups. Presentation skills
Experience organizing meetings and taking minutes
Knowledge of CPT, ICD-9 Codes
Exposure to contract language, rates, and coverage definitions
Computer literacy, including competence with various word processing and managed care programs. Microsoft Office familiarity
Demonstrated ability to communicate in a professional manner, have critical thinking skills, and work independently
Demonstrated ability to work effectively with a wide variety of people at all levels
Demonstrated ability to conduct on-line meetings and conference calls
Proven excellent organizational and people skills
Reliable transportation, valid California Driver’s License, and proof of insurance

Responsibilities

Coordinates and co-chairs all client board and regional meetings within assigned territory. Maintains official copies of minutes, agendas, and credential signatures at the MSO’s office. Sends announcements regarding scheduled meetings, makes phone calls to verify attendance (quorum), orders refreshments and sets up/breaks down the meetings. Prepares, or directs the preparation of, agendas, handouts, and meeting minutes. Represents management at all meetings with clients in an appropriate and professional manner
Serves as a resource for internal referrals on provider issues. Supports the Client Services Department in resolving provider issues and responds to training needs identified by other MSO departments such as Claims and Medical Management. Interfaces with Health Plan staff as required. Effectively problem solves issues as identified; documents all contact with providers/office staff in the provider’s file. Monitors’ clients need to evaluate satisfaction levels and identifies trends and areas requiring improvement
Manages the interface between providers, the MSO, and the health plans. Remains accessible to providers and their office staff. Leaves specific instructions about how to be reached within and outside the office. Utilizes email and the cell phone to maintain productivity within and outside the office. Schedules regular visits to physician offices to provide education, training, and customer service. Establishes and maintains solid, productive relationships with office staff by providing superior customer service and effectively solving issues. Stays current with activities in the market by developing an open rapport with the offices. Represents management at all meetings with clients in an appropriate and professional manner
Recruits providers in designated geographic areas, negotiates provider contracts within specified guidelines and assists the Director of Network Management in all phases of network negotiations and contracting. Investigates interested providers for consideration by the regional committee. Notifies health plans and appropriate internal departments of provider contract and status changes. Functions as a messenger between plans and IPA clients, as applicable, during contracting functions
Develops provider manuals, provider directories, provider communications, and other related materials; and facilitates the distribution of such information
Internet portal user set-up, training, documentation, communication and troubleshooting with vendors, as necessary
Completes other duties as requested and assigned