Network Provider Relations Representative - Plano, TX
January 13, 2018
Position Description: 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) Primary Responsibilities: All Customer Service issues regarding Providers contracts.All issues from Agents, Clients.All issues from Providers regarding their contract.Open and maintain tickets with CPO team regarding Provider contract issues and set up.Auditing of all claims for Projects received from UHC.Review all claims in PROS issues and investigate for root cause.Audit Repricing claims.Compare network allowable and determine ppo status to assist with RFP process.
Required Qualifications:High School Diploma / GED1+ year of healthcare claims and/or network operations experienceFamiliarity with audit re-pricing of claims and provider related contract issuesExperience utilizing Microsoft Word and Excel - Word - creating and editing documents; Excel - creating spreadsheets, filtering and sorting, etc. 1+ year of Healthcare experiencePreferred Qualifications:Healthcare claims customer service experienceSoft Skill:Ability to work independently and remain on task.Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.SMDiversity 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. Keywords: UnitedHealth Group, UHG, Provider Service Representative, healthcare claims, network operations, customer service.
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.