The Senior Provider Relations Advocate is responsible for the full range of provider relations and service interactions within UnitedHealth Group, 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. Senior Provider Relations Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Responsibilities also include directing and implementing strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims. Primary Responsibilities: Assess and interpret customer needs and requirementsIdentify solutions to non-standard requests and problemsSolve moderately complex problems and/or conduct moderately complex analysesWork with minimal guidance; seek guidance on only the most complex tasksTranslate concepts into practiceProvide explanations and information to others on difficult issuesCoach, provide feedback, and guide othersAct as a resource for others with less experienceCandidate must possess strong organizational skills. Must be able to shift priorities as business needs dictateCandidate must have strong analytical skills with the ability to create strategic plans and carry out those objectivesMust be able to communicate professionally and effectively with a wide range of individuals to gain partnership and cooperation in the implementation of processesIndependent travel is a component of this position
Required Qualifications: Undergraduate degree4+ years of provider relations and/or provider network experienceIntermediate level of proficiency in claims processing and issue resolution3+ years' experience with Medicare and Medicaid regulationsIntermediate level of proficiency with MS Word, Excel, PowerPoint and AccessPreferred Qualifications: Exceptional presentation, written and verbal communication skillsAbility to work independently and remain on taskGood organization and planning skillsAbility to prioritize and meet deadlines from multi-staff members within the departmentIf the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years. Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: provider relations, claims, Medicare, Medicaid, provider relations, provider network, claims processing, Fort Myers, FL, Florida
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.