Provider Relations Advocate - Remote in Idaho

UnitedHealth Group is a health care and well-being company dedicated to improving the health outcomes of millions around the world. Comprised of UnitedHealthcare and Optum, we work to build a better health system for all. Your contributions will help transform health care for years to come.

About the role

The Provider Relations Advocate is responsible for end-to-end HCBS provider claims, easing referrals to Providers using the UnitedHealthcare Link Self Help tool, and training and developing external provider education programs. You will design and implement programs to build and nurture positive relationships between the health plan and providers (Home and Community-Based Services Providers, Health Homes, State Designated Entities, and other atypical service providers). Responsibilities include directing strategies for HCBS provider network development, identifying network gaps, assisting with network contracting and adequacy, and remediating operational and claims issues.

Responsibilities

• Serve as the primary contact for the health plan to contracted and non-contracted HCBS providers to resolve servicing issues including claims, authorizations, contract copies, and provider communications (e.g., Wage Parity, Minimum Wage compliance).
• Act as the main point of contact for providers, strategically building relationships to resolve claims, prior authorization, and contract-related issues while managing a portfolio of HCBS provider accounts.
• Work closely with claims Subject Matter Experts (SMEs) like the FAST and CPM teams to audit claims, identify root causes, and address related questions.
• Regularly review open items and issues, maintaining a tracking document to ensure timely resolution.
• Communicate resolutions to providers within 48 hours of receiving notifications.
• Monitor the Provider Advocate mailbox daily, serving as the main point of contact for claims and inquiries from HCBS Providers for all atypical services.
• Escalate issue trends to the Network Director to reduce regulatory complaints filed by providers.
• Use data and facts to identify and solve problems within your area of expertise.
• Collaborate with the LTSS team on prior authorization issues to ensure full payment for billed services.
• Work with Clinical Practice Consultants to resolve gaps identified by providers that impact network agreements, satisfaction, and burden.
• Partner with your manager to address provider-identified gaps with the Provider Call Center, ensuring claims questions are reviewed and resolved.
• Demonstrate autonomy by prioritizing and organizing work to meet deliverable deadlines.
• Provide explanations and information to others on topics within your expertise.
• Perform outreach and education to providers on policies and procedures to maximize contractual benefits.
• Partner with the credentialing team to upload and review credentialing applications for new providers.
• Collaborate with the national contracting team on inquiries or delays related to contract execution.

Requirements

• Bachelor’s degree or 3+ years of equivalent experience.
• 3+ years of provider relations and/or provider network experience, preferably in HCBS.
• 3+ years of experience with healthcare and managed care/health plans.
• Intermediate proficiency in issue resolution.
• Intermediate knowledge of Medicare and Medicaid guidelines.
• Intermediate proficiency with MS Word and Excel.
• Willingness or ability to travel 25%.
• Resident of Idaho.

Qualifications

• Proven exceptional presentation, written, and verbal communication skills.
• Demonstrated ability to work independently and remain on task.
• Ability to prioritize and meet deadlines from multiple staff members.
• Strong organization and planning skills.
• Understanding of the provider data lifecycle (provider contracting, data load, directory, etc.).

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (eligibility requirements apply).

Pay

The salary for this role ranges from $60,200 to $107,400 annually based on full-time employment, depending on factors such as local labor markets, education, work experience, and certifications.