Working with hospitals and physicians, our provider relations professionals work in the details of health care. We talked to Eric R, Senior Sourcing Strategist at UnitedHealth Group about what it is like to work in these roles at a Fortune 6 organization.
Q1) Describe a provider relations career at UnitedHealth Group and what skills do you need?
Provider Relations professionals are our frontline support for our provider network. They work closely with our hospital and physician network to resolve any billing or claims issues and to educate our providers on systems and processes. Provider relations professionals need to have strong customer service, strong follow-up and strong problem solving skills.
Q2) Do you need previous health care experience to be successful at UnitedHealth Group?
A healthcare background is highly desired in provider relations roles. Provider Relations professionals spend a lot of time dealing with health care claims and medical coding – which are very industry specific.
Q3) What challenges do provider relations professionals work on within UnitedHealth Group?
Provider Relations professionals help manage our relationship with our provider network and there is a wide range of issues that they have to resolve for providers. A few of these could include - resolving claims issues, troubleshooting claims issues and contract loading issues, walking providers through contract language and administrative guidelines, and identifying payment errors.
Q4) What types of software do provider relations professionals use at UnitedHealth Group?
Provider Relations professionals work with a number of different systems but the ones they utilize most heavily would be claims processing systems (UNET, Cosmos, FACETS, Cactus, Amisys, NDB, ISET, etc) and contract repository systems (Emptoris, etc).
Q5) Explain what types of certification, if any, is important at UnitedHealth Group?
A medical coding certificate (CPC- Certified Professional Coder) would be beneficial in the role but is not a requirement.
Q6) Where can professionals obtain those certifications (accreditation though an association or entity)?
A CPC certification can be obtained through the AAPC (American Academy of Professional Coders). More information can be found at https://www.aapc.com.
Q7) What does a provider relations career journey look like at UnitedHealth Group and how does management support career growth?
Provider Relations professionals have a wide range of options from this role. They can move up to a team manager or director role within provider relations. They could also move into network contracting or possibly a role leading some of our quality improvement initiatives with our providers.
Q8) How would you describe the future of provider relations careers here? What industry trends do you think are important to pay attention to within this career?
The industry is moving away from fee for service and moving towards more value based care. This is where provider reimbursement is tied in with quality of care and not just based on services performed. Provider Relations professionals will need to help providers navigate through and adapt to these new reimbursement methodologies.
Q9) Can you describe a “typical day” for a provider relations professional here?
A typical day for a Provider Relations professional would center around provider interactions. The day would be filled with provider meetings (both over the phone and face to face). During these meeting they might be educating providers on systems and policies, dealing with claims issues, gathering documents for credentialing, etc. A typical day might also include a few internal meetings to discuss updates in network strategy and new policies.
Q10) Name three main challenges faced in a provider relations role?
The three main challenges facing Provider Relations professionals include:
•Educating providers on the changing healthcare landscape and regulations
•Resolving/troubleshooting complex claims issues
•Being able to understand the nuances between providers and adapt to meet their unique challenges.
Q11) How do provider relations professionals exemplify the mission in their careers at #UnitedHealth Group?
Provider Relations professionals focus heavily on our core value of relationships to help strengthen our relationships with providers and drive towards our mission of helping people live healthier lives.
Q12) What types of benefits are offered to employees at UnitedHealth Group?
We offer lots of types of competitive benefits from paid time off (PTO), holiday pay, adoption assistance, education support and more.
Q13) Why would former military personnel be a good fit for a provider relations role at UnitedHealth Group?
Military personnel demonstrate a lot of core values that would make them a valuable asset to UnitedHealth Group. Strong organization skills, the ability to multi-task, strategic and tactical problem solving, and the belief in working on a mission of helping people live healthier lives and to help the health system work for everyone are a few of the traits that would make them a great fit. Transitioning military can learn more about how we support military and veteran hiring and utilize our military skills translator.
Q14) How do I know if I’m a good fit for the culture?
UnitedHealth Group's 5 core values of integrity, compassion, relationships, innovation, and performance are all built around our mission of enhancing the performance of the health care system and helping people live healthier lives. People who are passionate about improving our health care system and can work in a fast-paced, ever-changing environment would be a great fit for UnitedHealth Group's culture.
Q15) How can I find out more about the provider relations roles at UnitedHealth Group?
You can view our open provider relations opportunities on our careers site.