[Hiring] Provider Relations Advocate @UnitedHealth Group

Role Description

The Provider Relations Advocate is responsible for working on end-to-end HCBS provider claims, ease of referral to Providers to use UnitedHealthcare Link Self Help tool, training and development of external provider education programs. HCBS Provider Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (Home and Community Base services Providers, Health Homes, State Designated Entity and other atypical service providers). Responsibilities also include directing and implementing strategies relating to the development and management of a HCBS provider network, identifying gaps in network composition and services to assist the network contracting, network adequacy and in identifying and remediating operational short-falls and researching and remediating claims.

• Serve as the primary contact for the health plan to our contracted and non-contracted HCBS providers managed by the health plan to resolve all provider servicing issues including claims, authorization, copies of executed contracts, provider communication such as notices for Wage Parity, Minimum Wage compliance.
• Serve as main point of contact for providers and strategically build relationships to resolve claims, prior and contract related issues managing a portfolio of accounts of HCBS providers to ensure a trusting relationship are developed and issues related to claims, prior authorization, and any other issues identified by the Providers or our internal leaders.
• Work closely with our claims Subject Matter Experts (SME) like the FAST and CPM team to complete sample audit of claims to identify root cause issues and address any related questions.
• Regularly review open items and issues, maintaining a tracking document to ensure timely and accurate resolution.
• Communicate resolution to the providers within 48 hours of receiving the notification.
• Monitor the Provider Advocate mailbox daily and serve as the main point of contact to answer questions related to claims and other inquiries submitted by the HCBS Providers for all atypical services managed by the health plan.
• Escalate appropriate issue trends to the Network Director for immediate resolution to reduce regulatory complaint filing by providers.
• Use pertinent data and facts to identify and solve a range of problems within area of expertise.
• Work closely with the LTSS team around prior authorization issues for all HCBS providers to ensure full payment for billed services are rendered.
• Work closely with the Clinical Practice Consultants to resolve gaps identified by providers which impact on provider network agreements, provider satisfaction and provider burden.
• Work with manager to resolve gaps identified by providers with Provider Call center to ensure provider claims questions are being appropriately reviewed and addressed.
• Demonstrate a high level of autonomy by prioritizing and organizing your own work to meet deliverables deadlines.
• Provide explanations and information to others on topics within area of expertise.
• Perform outreach and education to providers on policies and procedures to maximize the mutual benefit of a contractual relationship.
• Work in partnership with the credentialing team to upload and review credentialing applications for new providers.
• Work in partnership with the national contracting team regarding any inquiries or delays with contract execution.

Qualifications

• Bachelor’s degree OR 3+ years of equivalent experience.
• 3+ years of provider relations and/or provider network experience, preferably HCBS.
• 3+ years of experience with healthcare and managed care / health plans.
• Intermediate level of proficiency in issue resolution.
• Intermediate knowledge of Medicare and Medicaid guidelines.
• Intermediate level of proficiency with MS Word and Excel.
• Willing or ability to travel 25%.
• Resident of Idaho.

Preferred Qualifications

• Proven exceptional presentation, written and verbal communication skills.
• Demonstrated ability to work independently and remain on task.
• Demonstrated ability to prioritize and meet deadlines from multi-staff members within the department.
• Proven good organization and planning skills.
• Understanding of the provider data lifecycle (provider contracting, provider data load, provider directory, etc.).

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.