Senior Provider Relations Advocate - Remote in AZ

UnitedHealth Group•Phoenix, AZ

1d•$72,800 - $130,000•Remote

About The Position

This role supports provider network performance by strengthening provider relationships, resolving complex operational issues, delivering provider education, and partnering across claims, contracting, compliance, network, and operational teams. Jobs in this family manage provider networks that support the client base, including HCBS providers, assisted living facilities, and in-home support services. Responsibilities include provider relations activities, provider performance analysis, provider reimbursement arrangements, and credentialing activities. Positions in this function are accountable for the full range of provider relations and service interactions within UHG, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training and development of external provider education programs. Designs and implements programs to build and nurture positive relationships between the health plan, providers, and practice managers. Directs and implements strategies relating to development and management of a provider network. Identifies gaps in network composition and services to assist network contracting and development staff in prioritizing contracting needs. May also be involved in identifying and remediating operational shortfalls and researching and remediating claims. The Senior Provider Relations Advocate serves as a strategic partner between the health plan and the provider community, driving provider satisfaction, operational excellence, education, issue resolution, and regulatory compliance. This role functions as a subject matter expert and trusted advisor for provider-facing operations, claims and payment support, provider engagement, and cross-functional collaboration. Generally, work is self-directed and not prescribed. Works with less structured, more complex issues. Serves as a resource to others. Assesses and interprets customer needs and requirements. Identifies solutions to non-standard requests and problems. Solves moderately complex problems and/or conducts moderately complex analyses. Works with minimal guidance; seeks guidance on only the most complex tasks. Translates concepts into practice. Provides explanations and information to others on difficult issues. Coaches, provides feedback, and guides others. Acts as a resource for others with less experience. Field and virtual meetings with providers and internal partners, supporting high-complexity, high-volume, high-spend provider groups or specialties. If you are located in AZ, you will have the flexibility to work remotely as you take on some tough challenges.

Requirements

5+ years of healthcare or managed care experience
3+ years of provider relations or provider network experience
Medicare and/or Medicaid experience
Experience working directly with physician groups or hospitals
Solid claims knowledge
Proven advanced communication, presentation, and Microsoft Office skills
Demonstrate understanding of internal claims and payment policies and procedures; systems such as CSP, FACETS, ServiceNow, Spire, and the UHC provider portal; vendor platforms, EDI processes, and clearinghouses; provider contracting terminology and methodology; coding, billing, and reimbursement policies; policies and procedures impacting providers; fee negotiation protocols; branding, service tools, and outreach activities; industry trends, regulations, and health care reform; MS Office, PowerPoint, Excel, and relevant applications; and market trends and current events impacting the provider community
Gather data from claims, data warehouse, payment integrity, EDI/portal reporting, customer relations systems, and business partners
Collaborate with colleagues and business partners to identify potential root cause of issues
Analyze data to determine root cause, trends, patterns, outliers, and anomalies; escalate as necessary
Coordinate stakeholder solutions and ensure provider updates are communicated within defined metrics
Ensure provider data is accurate through audits, re-credentialing, and/or outreach
Provide onboarding and orientation to new providers
Develop resources and programs to assist and educate providers, including training and FAQs
Communicate industry and company information through newsletters, emails, outreach calls, teleconferences, conferences, and on-site meetings
Educate providers on policies, procedures, administrative tools, and clinical tools/processes
Analyze network adequacy and recruitment opportunities
Conduct recruitment activities and communicate network outcomes
Build and sustain effective provider relationships
Support recruiting and retention efforts by identifying and implementing service improvement opportunities
Solicit feedback and develop action plans; help providers improve performance under incentive contracts and accountable care strategies
Comply with applicable laws, regulations and policies; demonstrate integrity
Identify and exceed customer expectations; improve the customer experience
Collaborate with others; demonstrate diversity awareness; learn and develop
Influence others; listen actively; speak and write clearly
Contribute innovative ideas; work effectively in a changing environment
Apply business knowledge; use sound judgement
Drive for results; manage time effectively; produce high-quality work

Nice To Haves

Experience with Medicaid, Medicare Advantage, Dual Eligible, ALTCS, HCBS, behavioral health, hospital, facility, or ancillary providers
Experience with provider portals, EDI, EFT/ERA, eligibility, prior authorization, training delivery, and operational analytics

Responsibilities

Develop provider relationships
Resolve complex claims and operational issues
Educate providers on policies and regulatory requirements
Facilitate provider meetings and training
Identify trends and process improvement opportunities
Collaborate across claims, contracting, network, compliance, and operational teams
Support network initiatives
Mentor peers and serve as a resource