- Assist in efforts to enhance ease of use of physician portal and future services enhancements
- Assist providers and members with basic inquiries about claims, authorizations, benefits, and other issues
- Fostering and maintaining proactive, positive relations throughout the provider network by communicating with provider offices through face-to-face visits, emails, telephone calls, etc.
- Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers
- May also be involved in identifying and remediating operational short-falls and researching and remediating claims
- High School Diploma/GED (or higher)
- 2+ years of account management experience working with a medical group or IPA in a managed care environment
- 2+ years of experience working in a similar position in the healthcare industry or in customer service supporting providers and their offices
- 2+ years of experience in customer service in a health care setting
- 2+ years of experience with managed care and self-insurance products and benefits
- Ability to work in office 2-3 days a week at 1901 Solar Dr. Ste 200 Oxnard, CA 93036
- Ability to travel 20-30% of the time
- Experience working with HMO/IPA as well as health plan knowledge
- Familiarity with third party administrator operations such as eligibility, prior authorization, claims administration and provider network administration
- Organizational skills
- Project management
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Provider Relations Representative - Moorpark, United States - Optum
Description
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Provider Relations Representative is responsible for establishing and maintaining positive relationships with various clients building strong, cohesive business partnerships. Works with internal staff, client representatives, and other contracted entities to deliver contractual performance standards and ensure customer service objectives are continually met.
The Provider Relations Representative must have the ability to handle various situations in a professional manner, demonstrating excellent customer service at all times and ability to adapt to change. Must be able to work collaboratively with multiple internal departments as well as external organizations. Willingness to work as part of a team, working with others to achieve goals, solve problems, and meet established organizational objectives.
Location: 1901 Solar Dr. Ste 200 Oxnard, CA 93036
Hours: Monday through Friday from 8am-5pm PST
If you reside near Oxnard, CA, you will enjoy the flexibility of a hybrid-remote role as you take on some tough challenges.
Primary Responsibilities:
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:
Preferred Qualifications:
Soft Skills:
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
California Residents Only: The hourly range for California residents is $16.54 to $32.55 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
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