About the Role
Title: Provider Relations Advocate – Remote in MA
Location: Waltham MA US
Job Description:
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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This Dental Provider Relations Advocate role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We’re building better, more effective provider networks every day. In this role, you’ll use your solid customer service orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. As you do, you’ll discover the impact you want and the resources, backing and opportunities that you’d expect from a Fortune 6 leader.
The Dental Provider Relations Advocate is responsible for the full range of provider relations and service interactions within UnitedHealth Group, including being the face of UnitedHealthcare (UHC) Dental in the field with our providers and the liaison for provider contracting questions, claim and call quality, ease of use of provider web portal, future service enhancements and training & development of provider education programs. The role may be involved in identifying and remediating operation short-falls and researching and resolving complex claims and claims issues. The role also ensures the network composition includes an appropriate distribution of provider specialties, including recruitment and contracting as needed. This role may involve Commercial, Medicare and Medicaid programs.
This position will cover an assigned territory, but not necessarily limited to MA. The individual selected should live within/or proximal to MA to allow for provider visitation.
If you are located in the state of Massachusetts, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- FQHC relationship owner
- Provider relationship manager
- Targeted Provider recruitment
- Provider education
- Provider at risk escalation resource
- Member escalation contact
- Network adequacy manager
- Special project manager
- Market expert
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:
- 1+ years of experience in a network management related role, such as contracting, provider relations or provider services and/or experience working in a dental office
- 1+ years of experience with Medicaid and Medicare reimbursement methodology (ie. APG, PPS, FFS, Capitation)
- Basic level of proficiency with MS Excel
Preferred Qualifications:
- Provider contracting experience
- Knowledge of PPO reimbursement methodologies
- Knowledge of Dental products/providers
- Knowledge of claim processing systems and guidelines
- Proven excellent verbal and written communication skills
- Proven interpersonal skills, ability to establish rapport and work well with others
- Proven customer service skills
- Reliable transportation
- Reside in service area as noted above