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in Cypress, CA
Provider Relations Advocate - Cypress, CA - Full-time / Part-time
•30 days ago
Hours | Full-time, Part-time |
---|---|
Location | Cypress, CA Cypress, California |
About this job
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)
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.
Primary Responsibilities:
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)
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.
Primary Responsibilities:
- Use pertinent data and facts to identify and solve a range of problems within area of expertise.
- Investigate non-standard requests and problems, with some assistance from others.
- Work exclusively within a specific knowledge area .
- Prioritize and organize own work to meet deadlines.
- Provide explanations and information to others on topics within area of expertise.
- This position is in the Cypress office and is not a telecommute position. The travel will average anywhere from 5% to 25% because you are working with the capitated/delegated HMO providers in the Southern California. Understanding the HMO model and capitation as well as FFS lines of business is a plus. This individual will handle all lines of business. Commercial, Medicare, TRICARE and FFS Commercial.
- Analyzes and investigates.
- Provides explanations and interpretations within area of expertise.
- Field-based; Frequent on-site visits and meetings with physician groups or hospital systems. Smaller practices, lower spend & less complexity
Requirements
Required Qualifications:
- High School Diploma.
- 2+ years of Provider Relations and/or Provider Network experience.
- Experience in Claims processing and issue resolution.
- 1+ years experience with Medicare and Medicaid regulations.
- Experience working with with Microsoft Word, and Excel. Word - create correspondence and work within templates. Excel - data entry, sort/filter, basic formulas and tables
Diversity creates a healthier atmosphere: 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.