Optum hiring Provider Relations Advocate - Florida based in El Paso, TX | LinkedIn (2024)

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.   The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This Provider Relations Advocate role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We're building better, more effective provider networks every day. In this role, you'll use your strong customer service orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. As you do, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 5 leader.

Primary Responsibilities

• Assist in end-to-end provider claims and help enhance call quality
• Assist in efforts to enhance ease of use of physician portal and future services enhancements
• Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers
• Support development and management of provider networks
• Help implement training and development of external providers through education programs
• Identify gaps in network composition and services to assist network contracting and development teams

Are you ready for a challenge? You'll be part of a performance driven, fast paced organization that is serving multiple markets and you'll be charged with educating and building relationships with providers to evolve ongoing processes and programs.

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. *Employees in jobs labeled with ‘SCA’ must support a government Service Contract Act (SCA) agreement.

• 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

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• 4+ years of health care/managed care experience
• 2+ years of provider relations and/or provider network experience
• 2+ years of proficiency in claims processing and issue resolution
• 2+ years of experience facilitating Joint Operations Committee (JOC) meetings with provider and hospital personnel including clinical leaders
• 2+ years knowledge of Medicare provider types in rural areas such as (RHC, FQHC, CAH) facilities
• 1+ years of experience with Medicare and Medicaid regulations
• Experience in rural markets, e.g. RHCs and FQHCs
• Proficiency with MS Office: Word, Excel, PowerPoint and Access
• Proficiency in creating and presenting in large group settings
• Ability to travel up to 2 hour radius from your home base

Total Compensation. As part of your total compensation package, which includes base, bonus opportunity, PTO and holiday pay, you will also receive these benefits at these rates, not to mention a remote work opportunity and healthy work/life balance.

UHG Benefits

Benefits pricing

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.