[Hiring] National Senior Relations Advocate @UnitedHealth Group

Role Description

The Senior National Relations Advocate is responsible for managing comprehensive provider relations within OptumServe. This includes resolving provider claims and concerns, enhancing provider portal usability, and supporting education and training initiatives. The role fosters solid relationships with providers and account managers, contributes to network retention strategies, and addresses operational gaps. Key responsibilities include:

• Act as a subject matter expert for relations advocates, supporting training sessions, providing ongoing support to new hires, and offering guidance during office hours meetings.
• Educate providers on a wide range of topics to enhance their knowledge and compliance with policies, procedures, and best practices.
• Collaborate with provider network leadership to deliver targeted coaching to relations advocates, fostering skill development and performance improvement.
• Support provider network leadership in managing and executing priority requests with efficiency and accuracy.
• Utilize complex systems (MedNet, Tableau, Provider Portal, DMS, Sharepoint).
• Identify, analyze, and resolve complex provider issues.
• Ability to deescalate situations to ensure a positive provider experience.
• Skilled in Provider Retention and complaint resolution.
• Work closely with Relations advocates to provide support.
• Provide feedback and solutions to support process improvements.
• Propose relations manual updates as needed to ensure advocate success.
• Partner with Program Specialist to identify, understand, and/or improve internal tools, resources, systems, and capabilities.
• Partner with regional manager and associate director for advocate development.
• Routine audit advocate performance.
• Work with leadership to identify obstacles and barriers and develop a plan for advocates needing further assistance.
• Analyze data to determine root causes.
• Monitor KPIs to meet shared goals.
• Perform network analysis to identify potential recruitment opportunities.
• Communicate with contract manager to determine customer needs.
• Help providers understand and improve performance under accountable care strategies.
• Effectively and efficiently communicate clearly through written communication.
• Conduct auditing for operations to evaluate compliance with applicable regulatory requirements including OSHA and ADA.
• Lead in complex end-to-end provider claims processing and resolution.
• Perform basic fee negotiations.
• Resolve complex complaints within strict deadlines while ensuring accuracy and contractual compliance.
• Lead in efforts to enhance ease of use of physician portal and future services enhancements.
• Lead in identifying gaps in network composition and services to support network contracting and adequacy teams.
• Develop and maintain solid relationships with providers to ensure contractual compliance and effectively meet business needs.
• Utilize relevant data and facts to analyze and resolve a variety of issues within area of expertise, driving process improvement.
• Independently investigate and identify solutions to non-standard requests and problems.
• Manage and prioritize work effectively to meet deadlines.
• Provide explanations and information to others on topics within area of expertise.
• Coordinate meetings with providers to discuss a variety of topics, including JOC meetings.
• Attend and contribute to multi-department meetings.

Qualifications

• 2+ years of experience working with Microsoft Word, Excel, and Outlook.
• 2+ years of related experience (provider relations, network management, customer service, account services, and/or account management).
• Proven knowledge of provider contracting language, terminology, and processes.
• Demonstrated understanding of internal and external market trends.
• Proven ability to perform detailed work with exceptional accuracy and efficiency.
• Proven ability to travel as needed.
• Ability to work Monday-Friday 8am-5pm, shift varies based on business needs.
• Driver’s License and access to reliable transportation.

Requirements

• Experience working in Optum Serve as a Provider Relations Advocate, exceeding performance goals.
• Database experience (e.g., MedNet).
• Medical, dental, or healthcare insurance experience.
• VA knowledge or experience.
• Experience in continuous process, efficiency, and quality improvement.
• Proven working knowledge of healthcare terminology.
• Proven provider relations subject matter expert.
• Demonstrated understanding of claims, payment, and procedures.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).
• Hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment.