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Provider Relations Advocate - Cypress, CA
•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:
- 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/GED.
- 2+ years of Provider Relations and/or Provider Network experience.
- Experience working with with Microsoft Word, and Excel. Word - create correspondence and work within templates. Excel - data entry, sort/filter, basic formulas and tables.
Preferred Qualifications:
- Experience with Medicare and Medicaid regulations.
- Experience in Claims processing and issue resolution.
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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.
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