Senior Provider Relations Representative - Hillside, IL

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)

The Senior Provider Relations Representative will support in managing the results both financially and operationally of the IPA/PHO which assigned, accessing direction as needed from the assigned Administrator or Associate Administrator.

Primary Responsibilities:

• Conduct orientations/re-orientations with contracted physicians and providers


• Update provider offices on policies & procedures as necessary due to non-compliance and/or new health plan or IPA/PHO initiatives


• Determine/communicate/resolve office staff concerns


• Prepare and mail new physician contracts and follow-up upon approval from Membership Committee


• Negotiate one-time rate for out-of-network providers and prepare documentation


• Prompt 'F' report review to identify claims where PCPs have rendered care to members that have not chose that provider as his/her PCP


• Attendance at scheduled Health Plan meetings


• Maintain provider office tools including provider manual


• Responsible for meeting minutes and follow up on 'TO DO' items identified at meetings


• Maintain provider relationships through follow up with contracted providers


• Conduct monthly/quarterly client service calls/visits


• Other duties as assigned by management

Required Qualifications: 

• 2+ years of managed care experience, or 4+ years of work experience in a provider office environment


• Excellent oral and written communication skills, including all interpersonal skills


• Attention to detail


• Ability to work both independently and as part of a larger team, be well-organized


• Demonstrated knowledge of CPT, ICD-9, Medicare rules, RBRVS, & HCPCS coding


• Excellent logic and reasoning skills


• Job requires daily reliable transportation

Preferred Qualifications:

• Bachelor's degree


• Project Management skills and experience


• Limited knowledge of medical terminology

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

North American Medical Management specializes in working with leading physicians and hospitals to successfully manage the delivery of medical services. We have developed sophisticated techniques for managing the revenue and health care expenses of medical groups. NAMM currently provides MSO services to twelve PHOs and IPAs in the Chicago area serving about 90,000 managed care lives with positive results.

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Keywords: Provider Relations Rep, Relations Coordinator, Hillside, IL