Requisition number: 2356327
Job category: Network Management
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
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 performance analysis, reimbursement arrangements, dispute resolution, credentialing and training support, and escalations. As a subject matter expert, the advocate ensures contractual compliance and effective communication to maintain a broad, stable, and cost-effective provider network aligned with business goals.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Act as a subject matter expert for relations advocates, supporting training sessions, providing ongoing support to new hires and offering guidance to all relations advocates during office hours meetings and supporting a positive work environment
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
Work as a subject matter expert during new advocate training and provide ongoing support to new hires
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 that can maximize provider, member, and company support
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 that need 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, including but not limited to, claims reprocessing, modifying orders, and adhering to contractual guidelines within claim requirements
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, seeking leadership assistance only in the most extreme cases
Manage and prioritize work effectively to meet deadlines, ensuring timely responses to leadership, providers, and assigned tasks
Provide explanations and information to others on topics within area of expertise
Use pertinent data and facts to identify and solve a range of problems within area of expertise
Coordinate meetings with providers to discuss a variety of topics, including JOC meetings
Attend and contribute to multi-department meetings
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:
2+ years of experience working with Microsoft Word (creating and editing documents) Microsoft Excel (creating spreadsheets and general navigation), and Microsoft Outlook (Email and calendar)
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
Proven knowledge of provider contracting and ability to thoroughly understand the contracting documents and problem solve areas of opportunity
Demonstrated understanding of internal and external market trends and identify needs to assist with contracting efforts
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
Preferred Qualifications:
Experience working in Optum Serve as a Provider Relations Advocate, exceeding performance goals
Data base experience (ie 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
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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.
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.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
