[Hiring] Senior Provider Relations Advocate @UnitedHealth Group

Role Description

As a Senior Provider Relations Advocate, you will play a crucial role in supporting providers such as Aging Service Access Points (ASAPs) and Home and Community Based Providers (HCBS) within the Massachusetts market. You will focus on the Senior Care Option and One Care lines of business for UnitedHealthcare Community and State. This position requires a deep understanding of provider relations, healthcare regulations, and the ability to foster positive relationships with providers to ensure optimal service delivery and satisfaction.

Primary Responsibilities:

• Demonstrate a thorough understanding of policies and procedures impacting providers, including claims, appeals, complaints, benefits, regulatory requirements, and client business needs.
• Develop and maintain solid relationships with ASAPs, HCBS, and Community Based Organizations (CBOs).
• Serve as the primary liaison to providers, ensuring positive, productive, and informative interactions.
• Assist providers with claims issues, enhance the use of UHC’s provider portal, and troubleshoot inquiries to ensure optimal performance.
• Work collaboratively with Clinical, Sales, and other health plan and national departments to resolve issues and improve provider/customer satisfaction and growth.
• Review provider contracts and audit systems for correct contract configuration.
• Implement training and development programs for external providers through education initiatives.
• Provide coaching, feedback, and guidance to team members to foster professional growth and improve performance.
• Facilitate and lead quarterly Joint Operation Committee (JOC) meetings with select providers and their leadership teams.
• Contribute to efforts to enhance the ease of use of the UHC provider portal and future service enhancements.
• Design and implement programs that build and nurture positive relationships between the health plan, providers, and practice managers.
• Identify gaps in network composition and services to assist network contracting and development teams.

Qualifications

• High school diploma.
• 2+ years of experience in a managed care organization, network management, healthcare operations or provider relations related role, such as contracting or provider services.
• 2+ years of provider relations and/or provider network experience.
• Intermediate proficiency in MS Word, Excel, and PowerPoint.
• Ability to travel approximately 25% within Massachusetts.
• Driver’s License and access to reliable transportation.

Requirements

• 2+ years of experience with Medicare and Medicaid regulations.
• Experience with systems such as CSP Facets, NDB, and EDI processes.

Soft Skills

• Proven excellent organizational, planning, prioritizing, and multi-tasking skills.
• Proven exceptional presentation, written, and verbal communication skills.
• Proven ability to manage multiple tasks and projects simultaneously.
• Proven ability to work independently, in a team and cross-functionally (i.e., Clinical, Sales, Operations).

Benefits

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