Provider Relations Advocate - Remote in HI
Hybrid
Honolulu, HI, United States(flexible)
Honolulu, HI, United States(flexible)
Posted 19 days ago
Job Details
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. 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 & development of external provider education programs. Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs. May also be involved in identifying and remediating operational short-falls and researching and remediating claims. Generally, work is self-directed and not prescribed. This role will develop and execute the Chart Retrieval/Chase engagement strategy with key Provider Accounts, identifying and collaborating with key stakeholders of our largest Providers. Leaning on industry knowledge, built relationships and marketing savvy, the role will educate key Provider accounts on the benefits of the Retrieval program to gain alignment and participation. In this work, the role will partner with the UHN Contracting team and OptumHealth to execute the enterprise’s strategy, focusing on the risk adjustment and audit components of the Chart Retrieval/Chase work. If you are located within the state of Hawaii, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities:
- Assist in end-to-end provider claims and help enhance call quality
- Coach, provide feedback and guide others
- Assist in efforts to enhance ease of use of physician portal and future services enhancements
- Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers
- Help implement training and development of external providers through education programs
- Identify gaps in network composition and services to assist network contracting and development teams
- Work with less structured, more complex issues
- Serve as a resource to others
- This is a field-based role with occasional on-site visits and meetings with physician groups or hospital systems
- 5+ years of health care and/or managed care experience
- 3+ years of provider relations and/or provider network experience
- 1+ years of experience with Medicare and Medicaid regulations
- Experience working directly with physician groups or hospital systems in the provider community
- Intermediate level of proficiency in claims processing and issue resolution
- Intermediate proficiency with MS Word, Excel, PowerPoint
- Capitated/delegated or NICE Platform experience
- Experience with hospital and ancillary claims
- Proven solid presentation skills with experience and comfortability presenting to others
Learn more about UnitedHealth Group
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