Sr. Provider Relations Advocate -TN

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 Advocate is responsible for 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 Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Responsibilities also include directing and implementing strategies relating to the development and management of a provider network, identifying 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:

• Assess and interpret customer needs and requirements
  
• Identify solutions to non-standard requests and problem
  
• Solve moderately complex problems and/or conduct moderately complex analyses
  
• Work with minimal guidance; seek guidance on only the most complex tasks
  
• Translate concepts into practice
  
• Provide explanations and information to others on difficult issues
  
• Coach, provide feedback, and guide others
  
• Act as a resource for others with less experience

This role will support deployment and implementation of Episodes of Care model, a key state initiative in alliance with Tenncare our state partner and C&S. This position will serve as the SME for this initiative, provide support for manual distribution for receiving manual reports, outreach to negatively impacted providers with white glove phone calls, tracking of all outreach, fielding and tracking all questions and interactions with providers, management of par TIN list for Waves 1-3 and each subsequent wave, management of Optum and providers using Optum secure server, managing contract status with C&S healthplan, communication and training providers on waves 1-3 and all subsequent waves, and any ad hoc requests by Tenncare or C&S to engage providers in the overall management of the Episode process.

Required Qualifications:

• Undergraduate degree or equivalent experience
  
• 3+ years of provider relations and/or provider network experience
  
• Intermediate level of proficiency in claims processing and issue resolution
  
• 3+ years of experience with Medicare and Medicaid regulations
  
• Intermediate level of proficiency with MS Word, Excel, and PowerPoint

• Exceptional presentation, written and verbal communication skills
  
• Ability to work independently and remain on task
  
• Good organization and planning skills
  
• Ability to prioritize and meet deadlines from multi-staff members within the department

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.

Job Keywords: Provider Relations, Claims processing, Medicare, Medicaid, Brentwood, Knoxville, Memphis, Nashville, Johnson City, TN, Tennessee