Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm) This role 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 provider portal(s) 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 - including but not limited to home and community based & preventive service providers, physician, hospital, ancillary, etc., and practice / agency 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. Under the direction of the Director of Community & State Network Programs for RI, this role ensures that RI Community Plan maintains an adequate network of Home and Community Based Service (HCBS) Providers / Preventive Service Providers including but not limited to Adult Day Care, Personal Emergency Response, Home Modification, Homemaker, Personal Care Attendant and additional providers as appropriate. 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 experience Core Responsibilities: To support Community & State in six major areas of concentration as the HCBS & Preventive Services Provider Point of Contact:HCBS / Preventive Service Provider Contracting Support Distribution and monitoring of initial provider application, credentialing documents ensuring receipt prior to contract executionMaintain credentialing documentation ensure recredentialing (and monthly ongoing monitoring) is done in a timely manner and tracked in the databaseEnter & Maintain HCBS / Preventive Service Provider and contracting databases (creation, execution, loading, audit)Creates & Maintains state level policy & procedures for HCBS / Preventive Service networkCreates reports / dashboards (re: network, geo - access, etc.)Work with Clinical Care Teams to develop Single Case Agreements with Providers as neededHCBS / Preventive Service Provider Quality SupportConduct Site visits to ensure that facilities are clean and safe for member access (for Adult days & others as required)Validate that the Adult Day Care facilities are certified by the State (RI)Act as a liaison between Health Services outreach teams and HCBS / Preventive Service agenciesAlert Plan when inappropriate or unethical behavior is encounteredIdentify, facilitate, resolve Provider Demographic challenges / issues (outdated data, provider turnover, etc.) MembershipAct as a liaison between marketing and outreach teams and HCBS / Preventive Service agenciesSupport and collaborate to promote eventsAct as an ambassador to promote UnitedHealthcare to encourage agencies to recommend our Plan to their patientsHCBS / Preventive Service Provider Agency PerformanceParticipate in analysis of network with regards to referrals, case - mix and ratesShare referral data and results with providersFacilitate discussions between UHC C&S Clinical Team and agency for areas of concernOperational EfficiencyWork with UHC Performance Excellence Teams to focus on operational objectives such as including improvements in: % EDI / ERA/ EFT, % Claims Pending / Denied, etc.Train agency staff on provider portal tools & resourcesReview early warning reports for claims issues and assist with identification & resolution of root causesPersonally reinforce all administrative changes and updates in periodic face-to-face visitsHCBS / Preventive Service Provider Education & EngagementProvider Liaison - Provider welcoming, education and onboarding, navigating UHC & online tools, pertinent info on billing, policy, ongoing engagement & relationship with providers. Understanding HCBS Providers & their unique needsSupport & assist in resolving Provider issues related to claims submission and processing, authorizations - engaging appropriate operations staff, etc.Development, maintenance and compliance of the provider manual, provider newsletters and provider education and quick reference materials - working with UHC's HCBS National Complex care team and communications to author & updateCommunicate regulatory directed initiativesUpdate providers of UnitedHealth Group operational and organization changesPromote new initiatives and innovations, i.e. electronic medical records, etc.Work with Optum staff (HCBS / HBTS provider overlaps)Implement and support administrative simplification initiativesSupport & Participate in Town Hall MtgsSupports the development, HCBS Provider Survey (beginning for 2018)
Required Qualifications:Rhode Island on site presenceUndergraduate degree or equivalent work experience 4+ years of provider relations and / or provider network experienceIntermediate level of proficiency in claims processing and issue resolution3+ years of experience with Medicare and Medicaid regulationsIntermediate level of proficiency with Outlook, MS Word, Excel, PowerPoint, Access and contract database tools & technology Strong leadership and collaboration skills as it is necessary to work cross functionally and influence other teams, leadership and internal business partnersPreferred Qualifications:Exceptional presentation, written and verbal communication skillsAbility to work independently as well as within a team and to remain on task Excellent organization and planning skills, including the ability to communicate effectively with various levels of leadershipAbility to prioritize and meet deadlines from multi - staff members within the departmentStrong knowledge of business processes that impact contract loading and auditing Familiarity with the Rhode Island MarketCareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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, provider network, claims processing and issue resolution, Medicare and Medicaid regulations, Warwick, RI, Rhode Island
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.