Senior Provider Relations Representative - Plano, TX

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 chapters in health are. This is the place to do your life's best work.(sm)

The Senior Provider Relations Representative is responsible for assisting in 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 Representatives assist in the design and implementation programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Other responsibilities include supporting those who direct and implement strategies relating to the development and management of a provider network, identify 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:

• Use pertinent data and facts to identify and solve a range of problems


• Investigate non-standard requests and problems, with some assistance from others


• Prioritize and organize own work to meet deadlines


• Provide explanations and information to others on topics within area of expertise


• Focus on working with Skilled Nursing Facilities (nursing homes) across Texas


• Supporting the Provider Relations Advocates in the field and managing the general phone and email inquires related to the StarPlus Program


• Conduct initial research on claims issues and facilitate resolution


• Assist with preparing reports to the State on the PRA interactions with the Nursing Homes


• Educating key Nursing Home staff about UHC Community Plan and how to effectively work with the MCO for the StarPlus Program

Required Qualifications:

• Undergraduate degree


• 2+ years of managed care or medical insurance experience


• 1+ years of experience in a claims, customer service or provider support role


• Good organization and planning skills


• Strong interpersonal and oral communication skills including telephone etiquette


• Ability to prioritize and meet deadlines from multi-staff members within the department


• Strong research and analytical skills


• Basic level of proficiency with MS Excel and Word

UnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 14, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good. Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed. Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

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.

Job Keywords: Nursing home, medical billing, claims, data, manage database, SharePoint, Customer care, team lead, back office, Provider Relations, Plano, Texas, TX