Senior Provider Relations Advocate - Remote in AZ

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized.

About the role

This role supports provider network performance by strengthening provider relationships, resolving complex operational issues, delivering provider education, and partnering across claims, contracting, compliance, network, and operational teams. Jobs in this family manage provider networks that support the client base, including HCBS providers, assisted living facilities, and in-home support services.

Positions in this function are accountable for the full range of provider relations and service interactions within UHG, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training and development of external provider education programs.

The Senior Provider Relations Advocate serves as a strategic partner between the health plan and the provider community, driving provider satisfaction, operational excellence, education, issue resolution, and regulatory compliance. This role functions as a subject matter expert and trusted advisor for provider-facing operations, claims and payment support, provider engagement, and cross-functional collaboration.

Responsibilities

• Develop provider relationships
• Resolve complex claims and operational issues
• Educate providers on policies and regulatory requirements
• Facilitate provider meetings and training
• Identify trends and process improvement opportunities
• Collaborate across claims, contracting, network, compliance, and operational teams
• Support network initiatives
• Mentor peers and serve as a resource
• Design and implement programs to build and nurture positive relationships between the health plan, providers, and practice managers
• Direct and implement strategies relating to development and management of a provider network
• Identify gaps in network composition and services to assist network contracting and development staff in prioritizing contracting needs
• Identify and remediate operational shortfalls and research and remediate claims
• Assess and interpret customer needs and requirements
• Identify solutions to non-standard requests and problems
• Solve moderately complex problems and/or conduct moderately complex analyses
• Provide explanations and information to others on difficult issues
• Coach, provide feedback, and guide others
• Conduct field and virtual meetings with providers and internal partners, supporting high-complexity, high-volume, high-spend provider groups or specialties
• Demonstrate knowledge of relevant systems, operations, processes, and trends
• Gather data from claims, data warehouse, payment integrity, EDI/portal reporting, customer relations systems, and business partners
• Collaborate with colleagues and business partners to identify potential root cause of issues
• Analyze data to determine root cause, trends, patterns, outliers, and anomalies; escalate as necessary
• Coordinate stakeholder solutions and ensure provider updates are communicated within defined metrics
• Ensure provider data is accurate through audits, re-credentialing, and/or outreach
• Provide onboarding and orientation to new providers
• Develop resources and programs to assist and educate providers, including training and FAQs
• Communicate industry and company information through newsletters, emails, outreach calls, teleconferences, conferences, and on-site meetings
• Educate providers on policies, procedures, administrative tools, and clinical tools/processes
• Analyze network adequacy and recruitment opportunities
• Conduct recruitment activities and communicate network outcomes
• Build and sustain effective provider relationships
• Support recruiting and retention efforts by identifying and implementing service improvement opportunities
• Solicit feedback and develop action plans; help providers improve performance under incentive contracts and accountable care strategies

Requirements

• 5+ years of healthcare or managed care experience
• 3+ years of provider relations or provider network experience
• Medicare and/or Medicaid experience
• Experience working directly with physician groups or hospitals
• Solid claims knowledge
• Proven advanced communication, presentation, and Microsoft Office skills

Preferred Qualifications

• Experience with Medicaid, Medicare Advantage, Dual Eligible, ALTCS, HCBS, behavioral health, hospital, facility, or ancillary providers
• Experience with provider portals, EDI, EFT/ERA, eligibility, prior authorization, training delivery, and operational analytics

Skills

• Provider Relationship Management
• Claims Resolution
• Provider Education
• Escalation Management
• Regulatory Compliance
• Strategic Communication
• Cross-Functional Collaboration
• Process Improvement
• Data Analysis
• Coaching and Mentoring
• Understanding of internal claims and payment policies and procedures
• Systems such as CSP, FACETS, ServiceNow, Spire, and the UHC provider portal
• Vendor platforms, EDI processes, and clearinghouses
• Provider contracting terminology and methodology
• Coding, billing, and reimbursement policies
• Policies and procedures impacting providers
• Fee negotiation protocols
• Branding, service tools, and outreach activities
• Industry trends, regulations, and health care reform
• MS Office, PowerPoint, Excel, and relevant applications
• Market trends and current events impacting the provider community

Benefits

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).

Pay

The salary for this role will range from $72,800 - $130,000 annually based on full-time employment.