Senior Provider Relations Advocate

UnitedHealth Group•Boston, MA

3d•$72,800 - $130,000•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. As a Senior Provider Relations Advocate, you will play a crucial role in supporting providers such as Aging Service Access Points (ASAPs) and Home and Community Based Providers (HCBS) within the Massachusetts market. You will focus on the Senior Care Option and One Care lines of business for UnitedHealthcare Community and State. This position requires a deep understanding of provider relations, healthcare regulations, and the ability to foster positive relationships with providers to ensure optimal service delivery and satisfaction. There are changes happening in health care that go beyond the basics we hear in the news. People like you and organizations like UnitedHealth Group are driving ever higher levels of sophistication in how provider networks are formed and operate. The goal is to improve quality of service while exploring new ways to manage costs. Here’s where you come in. You’ll use your solid customer service orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. As you do, you’ll discover the impact you want and the resources, backing and opportunities that you’d expect from a Fortune 5 leader. If you are located within Massachusetts, Rhode Island, or New Hampshire, you will have the flexibility to work remotely as you take on some tough challenges.

Requirements

High school diploma
2+ years of experience in a managed care organization, network management, healthcare operations or provider relations related role, such as contracting or provider services
2+ years of provider relations and/or provider network experience
Intermediate proficiency in MS Word, Excel, and PowerPoint
Ability to travel approximately 25%25 within Massachusetts
Driver’s License and access to a reliable transportation

Nice To Haves

2+ years of experience with Medicare and Medicaid regulations
Experience with systems such as CSP Facets, NDB, and EDI processes
Proven excellent organizational, planning, prioritizing, and multi-tasking skills
Proven exceptional presentation, written, and verbal communication skills
Proven ability to manage multiple tasks and projects simultaneously
Proven ability to work independently, in a team and cross-functionally (i.e., Clinical, Sales, Operations)

Responsibilities

Demonstrate a thorough understanding of policies and procedures impacting providers, including claims, appeals, complaints, benefits, regulatory requirements, and client business needs
Develop and maintain solid relationships with ASAPs, HCBS, and Community Based Organizations (CBOs) Serve as the primary liaison to providers, ensuring positive, productive, and informative interactions
Assist providers with claims issues, enhance the use of UHC’s provider portal, and troubleshoot inquiries to ensure optimal performance
Work collaboratively with Clinical, Sales, and other health plan and national departments to resolve issues and improve provider/customer satisfaction and growth
Review provider contracts and audit systems for correct contract configuration
Implement training and development programs for external providers through education initiatives by resolving provider claims issues, enhancing the use of UHC’s provider portal, and troubleshoot provider inquiries for optimal performance
Provide coaching, feedback, and guidance to team members to foster professional growth and improve performance
Facilitate and lead quarterly Joint Operation Committee (JOC) meetings with select providers and their leadership teams
Contribute to efforts to enhance the ease of use of the UHC provider portal and future service enhancements
Design and implement programs that build and nurture positive relationships between the health plan, providers, and practice managers
Identify gaps in network composition and services to assist network contracting and development teams