Advisory Consultant, Senior Provider Relations Advocate – Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. 

Primary Responsibilities:

• Foster and maintain positive working relationships with network providers and third-party networks for commercial and Marketplace plans by responding to provider and third-party network inquiries related to the processing of health insurance claims
• Serve as resource for network providers and third-party networks by researching, communicating, and resolving contracting, credentialing, network status, provider demographic and service location, fee schedule, web portal, timely filing, claims processing, coding and billing, EDI, and product and benefit issues
• Enhance the relationship between Customer and network providers, facilitate provider conference calls to resolve outstanding customer and provider issues
• Communicate new policy, benefit, and network information to providers during conference calls, in provider newsletters, in the provider portal
• Supply providers with copies of fee schedules extracted from the Facets system in an Excel format for uploading into their systems
• Engage providers, to drive quality measures for HEDIS and risk adjustment opportunities. Facilitate report delivery to providers for population health management opportunities
• Participate in the Request for Proposals (RFP) process to gain new sales or retain existing sales by reviewing, updating, and summarizing provider network disruption, discount analysis, and network adequacy reports
• Publish and distribute provider reimbursement policies and a provider network newsletter on a quarterly basis, and develop and update a provider manual as needed, to inform network providers of claim status, coding, policy, and benefit updates and changes

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:

• High school diploma or equivalent experience
• 3+ years of health care/managed care experience
• 3+ years of experience in claims processing and issue resolution
• 3+ years of claims platforms or healthcare platforms experience
• 1+ years of experience with CPT and ICD-10 coding
• Proficiency with MS Office suite (Word, Excel, PowerPoint and Access)
• Ability to travel up to 25% when required

Preferred Qualifications:

• Undergraduate degree
• Experience with Facets 
• Experience in provider billing capacity, claims level audit, recovery operations experience with claims data knowledge 
• Proven excellent verbal and written communication skills with the ability to communicate effectively with external providers 
• Proven ability to prioritize tasks and work independently and effectively under time constraints 
• Proven solid interpersonal skills, establishing rapport and working well with internal partners 
• Proven solid analytical, critical reasoning and organizational skills 
• Proven solid customer service skills with critical thinking skills and confidence to evaluate and develop solutions

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. 

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.    

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.