Provider Claims Liaison - Metairie, LA - Full-time / Part-time

Position Description:UnitedHealthcare, a UnitedHealth Group company, provides
network-based health and well-being benefits and services for employers and
consumers nationwide. We use our strength, diversity and innovation to improve
the lives of the more than 18 million people who receive our unique products
and services, and our endless pursuit for excellence in everything we do
extends to your career as well.

 

Drive adoption of an enhanced Provider Service Model in local
market field offices and to escalate and drive timely, complete and accurate
resolution of service issues which failed resolution through the Provider
Service Unit and Claims Project Management processes.  Serve as the
provider service subject matter expert and primary escalation/delegation point
for local market teams when providers present service issues unresolved by the
first or second level resolution processes.

 

Primary Responsibilities:

Educate
contracted and non-contracted providers (i.e., professional and institutional)
regarding appropriate claims submission requirements, coding updates,
electronic claims transactions and electronic fund transfer, and available
Contractor resources such as provider manuals, website, fee schedules, etc.Serve as point of contact for centralized service units when local
market information or action is required to resolve/manage service issuesPromptly escalate and initiate expedited resolution actions within
the Service Model, monitor resolution progress, and establish regular
communication with the provider until complete resolution achieved.Document and communicate Service Model performance issues.Support and participate in Service Model process and performance
improvement activities.Reinforce Network Management provider education activities re:
navigation of service resolution paths.Facilitate management of complex service and/or service issues in
conjunction with the Market Lead, including analysis of service failures to
determine course of action to resolve the service issue and ensure service
process and/or performance gaps are documented and addressed.Collate, evaluate, and report on service issues/risks/trends to
support Network Mgmt contract negotiations and relationship mgmt for Tier 1
providers.Ongoing efforts to identify and resolve global root cause drivers
of claims/service issues.Interface
with the Contractor's call center to compile, analyze, and disseminate
information from provider callsIdentify
trends and guides the development and implementation of strategies to improve
provider satisfaction. Frequently communicate (i.e.: telephonic and on-site)
with providers to assure the effective exchange of information and gain feedback
regarding the extent to which providers are informed about appropriate claims
submission practices

Requirements:High School Diploma/GED.Travel required ranging from 25-50%.3+ years of experience in a managed healthcare environment.Experience with MS Word, Excel and PowerPoint (PowerPoint - creating and editing presentations. Word - creating and editing documents.  Excel - creating and editing spreadsheets).Experience with provider relations issue resolution and conflict management skills required.Claims and billing experience required (examples of experience include: Claims processor, Claims auditor, Claims examiner, Certified Coder, etc).Preferred:Bachelor's Degree preferred 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
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.