Member\/ Provider Relations Advocate - Remote in West Virginia

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The Provider Relations Advocate is responsible for member advocacy for members residing in long term care facilities along with the full range of provider relations and service interactions within Optum, including working on end-to-end provider issue resolution, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Provider Relations Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (physician, facilities, etc.), and practice managers. Responsibilities may also include the project management of complex issue resolution involving cross functional teams.

If you are located in the state of West Virginia, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:
  • Engagement with internal resources to project manage provider issue resolution (claims, credentialing, provider set-up)
  • Provider education and outreach regarding policies, processes, and ease of use of our provider self-service portal, provider express
  • Responsible for the delivery of external provider training and education programs either in-person, virtually or through larger external provider events
  • Build and nurture trusted relationships with high touch and territorial providers in assigned counties for all LOB.
  • Establish recurring monthly meetings with assigned high-touch providers to discuss outstanding issues and the appropriate escalation path for resolution
  • Onsite Member Visits: Act as the facility guardian angel when doing individual member visit rounds (if/when advocate finds anything unsafe or damaged e.g. closet doors off track, spills, residents in distress, etc., the MA alerts the nurses station immediately)
  • Carry out open communication/discussions with members and/or responsible parties about member coverage/benefits, rights and responsibilities, complaints, concerns, etc.
  • Coordinate solutions for any/all requested support for member services by the APC
  • Educate SNF schedulers/transporters on coordinating benefit verification and/or authorizations with community based PAR/NONPAR providers along with onsite support for full-day SNF "batch visits" by optometry, podiatry and audiology specialists.
  • Provide disenrollment assistance with the APC, SNF, member, POA, etc.
  • Maintain tracking on Hospice transitions outside of the SNF
  • Participate and/or sponsor facility/resident events to include but not limited to Quarterly Member Retention and Staff Appreciation Events
  • Deliver via email bi-monthly LIS Evidence Rider Notices, Rosters, and ID-Cards to the SNF
  • Create bi-monthly membership accounting reports for the health plan partners
  • Make monthly Healthplan Quality Assurance calls to SNF departments and to member POAs
  • Communicate weekly to the SNFs of upcoming new membership and/or disenrollments transitions (utilizing and monitoring the TRR)
  • Assists with LIS applications and/or BAE for members
  • Conduct Annual Member Satisfaction Surveys
  • Support any/all Network Management Contracting & Credentialing needs


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:
  • High school diploma/GED or above
  • 2+ years of provider relations and/or provider network experience
  • 2+ years of experience with Medicare and Medicaid regulations
  • 2+ years presentation experience
  • Intermediate level of proficiency in billing / coding / claims analysis; claim issue resolution
  • Intermediate level of proficiency with MS Excel
  • Valid driver's license


Preferred Qualifications:
  • Undergraduate degree
  • Experience with providers in this region
  • Provider Relations experience at the facility level
  • Excellent communication skills
  • Solid organization and planning skills
  • Ability to work independently
  • Demonstrated ability to build strong relationships with providers and with internal departments


Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Senior Provider Relations Advocate, Provider Relations Representative, Growing Business Line (Behavioral Health), Telecommute, Telecommuting, Telecommuter, Work from Home, Work At Home, Remote, WAH, Charleston, WV, West Virginia, #RPO

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