Provider Relations Advocate

About the role

Logistics Health Incorporated (LHI), part of the Optum family of businesses, simplifies the logistics of complex workforce health programs with cost-effective solutions and seamless distribution. With offices in La Crosse, Wis., a satellite office in Chicago, and remote employees nationwide, LHI offers a variety of rewarding career opportunities. Optum Serve Health Services (OSHS), one of three businesses under Optum Serve, provides health care services and expertise to help federal agencies modernize the U.S. health system and improve the health and well-being of Americans. OSHS specializes in creating and managing health care programs through on-location services, patient-specific in-clinic appointments, telehealth assessments, or any combination based on customer need, serving commercial customers as well as federal and state agencies including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

The Provider Relations Advocate maintains a successful working relationship between Optum Serve and network providers through a full range of provider relations and service interactions to ensure provider retention. This role identifies and remediates operational shortfalls, responds to customer complaints and satisfaction surveys, resolves provider questions, and researches and resolves accounts payable issues. The advocate routinely negotiates cost-effective fees for single services, confirms service capability, and educates providers on contract expectations, processes, and paperwork. Detailed knowledge of customer requirements is essential to translate subcontractor agreements, contractual requirements, and fee agreements to providers, and the advocate must routinely evaluate and analyze the most beneficial solution for Optum Serve and network providers in a variety of circumstances.

Schedule

A 40-hour work week, Monday through Friday, with a flexible schedule determined by the supervisor upon hire in 8-hour shifts between 8:00 am and 6:00 pm.

Location

Remote nationwide. You will enjoy the flexibility to telecommute from anywhere within the U.S. All telecommuters must adhere to UnitedHealth Group's Telecommuter Policy, including access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI), and a UnitedHealth Group approved high-speed internet connection or existing high-speed internet service.

Responsibilities

• Assess and resolve specific provider concerns, developing and implementing solutions beneficial to providers, LHI customers, and LHI
• Educate providers on fee structures to ensure collaborative agreement and understanding of LHI services and associated fees
• Staff the Provider Relations telephone queue, adequately respond to and resolve incoming calls appropriately
• Respond to customer satisfaction surveys and customer complaints within required time frames through investigation and problem solving that results in positive outcomes
• Provide explanations and information to others on topics within area of expertise
• Proactively review and maintain provider compliance documents to ensure active status within the provider network
• Collaborate with other departments to assign qualified providers to orders within the contractually allowed mileage radius of the patient's home zip code
• Assist in complex end-to-end provider claims processing and resolution, including claims reprocessing, modifying orders, and adhering to contractual guidelines within claim requirements
• Resolve complex complaints within strict deadlines while ensuring accuracy and contractual compliance
• Assist in efforts to enhance ease of use of physician portal and future service enhancements
• Assist in identifying gaps in network composition and services to support network contracting and adequacy teams
• Utilize relevant data and facts to analyze and resolve a variety of issues within area of expertise
• Investigate and identify solutions to non-standard requests and problems, with some assistance from others
• Manage and prioritize work effectively to meet deadlines, ensuring timely responses to leadership, providers, and assigned tasks
• Use pertinent data and facts to identify and solve a range of problems within area of expertise
• Educate providers on a wide range of topics to enhance their knowledge and compliance with policies, procedures, and best practices
• Act as a resource for others with less experience and promote a positive work environment
• Coordinate meetings with providers to discuss a variety of topics, including JOC meetings
• Attend and contribute to multi-department meetings
• Travel as needed (approximately 10% of the time within 100 miles of assigned territory)
• Perform other duties as assigned

Qualifications

Required:

• High School Diploma or GED
• 1+ years of experience in provider relations
• 1+ years of computer proficiency with Microsoft Office (Word, Excel, Outlook) and ability to access multiple web applications
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
• Ability to work an 8-hour shift between 8:00 am – 6:00 pm Monday through Friday based upon business needs
• Access to reliable transportation and a current, non-restricted state driver's license with state-required insurance
• Ability to travel 10% of the time within 100 miles of assigned territory

Preferred:

• Knowledge of rates and managing subcontractor relationships
• Knowledge of MedNet
• Ability to effectively manage provider accounts resulting in provider retention
• Ability to develop strong professional relationships while demonstrating a clear understanding of complex business structures
• Knowledge of medical terminology

Soft Skills:

• Ability to work independently and maintain good judgment and accountability
• Demonstrated ability to work well with health care providers
• Strong organizational and time management skills
• Ability to multi-task and prioritize tasks to meet all deadlines
• Ability to work well under pressure in a fast-paced environment
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner others can understand, and ability to understand and interpret information from others

Benefits