Senior Provider Relations Representative

UnitedHealth Group•San Diego, CA

21h•$72,800 - $130,000•Onsite

About The Position

This role serves as the primary liaison between clients and the MSO (Managed Service Organization) for the delivery of Managed Care Administrative Services. The representative is responsible for providing clear and complete explanations of services from each MSO Department to assigned IPA (Independent Practice Association) groups and resolving any issues that arise between them. Additionally, the role involves identifying opportunities for process improvement and supporting strategies for long-term relationship management with provider groups.

Requirements

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

Responsibilities

Coordinates and conducts meetings within assigned territory, maintaining official copies of minutes, agendas, and credentialing signatures. Sends meeting announcements, verifies attendance, orders refreshments, and handles meeting setup/breakdown. Prepares or directs the preparation of agendas, handouts, and meeting minutes. Represents management professionally at all client meetings.
Serves as a resource for internal referrals on provider issues, supporting the Client Services Department in resolving issues and responding to training needs from departments like Claims and Medical Management. Interfaces with Health Plan staff as needed, effectively problem-solves identified issues, and documents all provider contact. Monitors client needs to evaluate satisfaction, identify trends, and pinpoint areas for improvement. Collaborates with teams to refine training content and improve cross-departmental processes.
Manages the interface between providers, the MSO, and health plans, remaining accessible to providers and their staff. Provides specific instructions for contact within and outside the office, utilizing email and cell phone for productivity. Schedules regular visits with physician offices for education, training, and customer service. Establishes and maintains strong relationships by providing superior customer service and solving issues. Stays current with market activities through open rapport with offices. Represents management professionally at client meetings. Collaborates with leadership to prioritize high-impact providers and proactively address network challenges.
Recruits providers in designated geographic areas, negotiates provider contracts within guidelines, and assists the Director of Network Management in all phases of network negotiations and contracting. Investigates interested providers for regional committee consideration. Notifies health plans and internal departments of provider contract and status changes. Acts as a liaison between plans and IPA clients during contracting.
Develops and facilitates the distribution of provider manuals, directories, communications, and other related materials.
Provides feedback and recommends updates to materials to ensure clarity, consistency, and alignment with regulatory changes.
Handles internet portal user setup, training, documentation, and troubleshooting with vendors. Monitors common user issues and collaborates with IT to improve portal functionality and user experience.
Completes other duties as requested and assigned. May participate in cross-functional initiatives or special projects to support department and organizational goals.