Provider Relations Advocate - North Riverside County, CA residency required
UnitedHealth Group
- Murrieta, CA
- $58,300-114,300 per year
- Permanent
- Full-time
- Serve as single-point-of-contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract reimbursement, Optum’s internal processes and priorities, and other Optum initiatives, as applicable
- Monitors performance of assigned PCPs, identifies low performing PCPs and works with IPA leadership to develop action plan for specific metrics needing improvement. Works with office to effectuate action plans and monitors progress
- Intervenes and escalate issues as appropriate
- Maintains awareness of providers interested in further engaging with Optum on new business opportunities (contracts and business combinations), and on shifting market/competitive dynamics that would impact the IPA
- Works collaboratively with offices and Optum growth team to drive membership growth and retention
- Responds timely (within one business day) to provider issues, works with other groups/central departments to resolve issues and updates providers and office staff regularly through to resolution
- Build collaborative relationships with IPA physicians and their office staff
- 2+ years of health care/managed care experience
- 2+ years of provider relations and/or provider network experience
- Experience with Medicare and Medi-Cal regulations
- Understanding of healthcare systems billing
- Intermediate level of proficiency in claims processing and issue resolution
- Proficiency with Microsoft Office Suite
- Ability and willing to work a hybrid schedule (in the office 3 days per week when not in the field)
- Ability and willing to travel 50% within assigned territory