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 Operations Advocate is responsible for the full range of provider relations and operations tasks, including working on end-to-end provider claim and call questions and projects. Identify opportunities for ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Senior Provider Relations Operations Advocates 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, and identifying gaps in network composition and services to assist the network contracting. The will be involved in reporting, 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 requirementsIdentify solutions to non - standard requests and problems.- Solve moderately complex problems and/or conduct moderately complex analysesWork with minimal guidance; seek guidance on only the most complex tasksTranslate concepts into practiceProvide explanations and information to others on difficult issuesCoach, provide feedback, and guide othersAct as a resource for others with less experienceImpact of work is most often at the team levelCoordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit. Assists in resolution of State concerns, implements new State regulation as pertains to Network. Handles Network operation functions to meet State requirements, duties include but not limited to: Develops reports to meet State requirements, Member notification process, Access and Availability monitoring, PCP Panel monitoring, PCP transfers, Provider load issues, State Provider file, Encounter submissions. Provides oversight for vendor management that include, Vision, Pharmacy, Transportation, Radiology Prior Authorization, Access & Availability, and UHG segment management.
Required Qualifications:Undergraduate degree or equivalent work experience 4+ years of provider relations and/or provider network experience3+ years of experience with Medicare and/or Medicaid regulationsIntermediate level of proficiency in claims processing and issue resolutionIntermediate level of proficiency with MS Word, Excel and PowerPoint Ability to work independently and remain on taskDetail oriented with excellent follow up skillsMust live within commutable distance of the location listed for this specific career opportunityPreferred Qualifications:Exceptional presentation, written and verbal communication skillsGood organization and planning skillsAbility to prioritize and meet deadlines from multi-staff members within the departmentMS Access, MS Office ApplicationReporting and analytical experienceFacet experience Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.SM 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. Keywords: Provider Relations, Provider Advocate, NE, Nebraska, Omaha, Lincoln, Medicare, Medicaid regulations
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.