30 days old

Provider Relations Specialist - in Wausau, San Antonio or Cincinnati - 921306

Wausau, WI 54403
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  • Job Code
    921306

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.SM

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The position champions UMRs network offerings with our customers and assists in a full range of customer support to include procedures and processes related to new PPO business implementation and optimization for new and existing customers.

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Primary Responsibilities:

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  • Support Account Management, customers and internal units to implement new, expanded and/or existing provider network relationships. Involved in day to day troubleshooting on PPO issues and maintains an active and positive relationship with our PPO partners.
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  • Maintains strong relationships with internal departments to support customer implementation activities and provider network needs. Responsibilities to include, but not limited to, all procedures related to new PPO business implementation requirements for new and existing customers, PPO termination procedures and all other network related activities.
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  • Develops, maintains, reviews and distributes internal communications, to include but not limited to, significant changes involving provider networks, preparation and distribution, employee notifications for ID card changes and processing Work Orders for existing customers.
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  • Facilitates the resolution of provider network issues affecting internal and external customers. Addresses network issues with customers. Identifies and recommends solutions. Works closely with Provider Network Operations.
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  • Responsible for provider network renewal analysis to optimize our network relationships for existing customers on renewal or upon request. Ability to provide follow up and track the success of recommendations. Ability to request, prepare and review a variety of network analysis based on discount and provider access.
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  • Reviews and facilitates provider network approval of ID cards for network accuracy and completeness.
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  • Provides customer service by answering provider network questions, resolving elevated claim issues (prompt pay, balance billing, etc.) and attending customer meetings as required. May be required to coordinate claim issues involving Provider Network Operations.
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  • Maintains and/or monitors the provider nomination process.
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  • Prepares a variety of reports involving network activities.
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  • Monitors discount guarantees for the customers and network performance guarantees for the PPOs. Orders PPO directories, if necessary.
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  • Understands and supports the Rules of the Road for all PPO networks including Options and Choice Plus.
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  • Ability to process and monitor the exception requests for network quilting, benefit plans and Choice Plus exceptions.
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  • Maintains and supports work-flow, adapting to changing needs of the organization, by effectively communicating with internal and external areas.
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  • The Network Specialist is expected to be the subject matter expert regarding all PPO networks.
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  • Apply knowledge/skills to a range of moderately complex activities.
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  • Demonstrate great depth of knowledge/skills in own function.
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  • Sometimes act as a technical resource to others in own function.
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  • Proactively identify solutions to non-standard requests.
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  • Solve moderately complex problems on own.
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  • Work with team to solve complex problems.
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  • Plan, prioritize, organize and complete work to meet established objectives.
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  • May coordinate work of other team members such as Network Assignments and scheduling training sessions.
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  • Contributes to a team effort by performing other duties as may be assigned.
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Youll 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.

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Required Qualifications:

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  • High School Diploma/GED or above
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  • 4+ years of Managed Care or Medical Insurance experience.
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  • 2+ years of experience in a Claims, Customer Service or Provider Support role.
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  • Intermediate level of proficiency with MS programs including Excel and Word.
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  • You will be asked to perform this role in an office setting or other company location.
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas, In addition, employees must comply with any state and local masking orders.
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Preferred Qualifications:

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  • Intermediate level of Research and Analytical Skills.
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Soft Skills:

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  • Experience in a role requiring the ability to work independently and remain on task.
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  • Experience in a role requiring good organization and planning skills.
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  • Experience in a role requiring strong interpersonal and oral communication skills including telephone etiquette.
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UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

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You can learn more about all we are doing to fight COVID-19 and support impacted communities: click here.

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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.

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

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Keywords:Provider Relations Specialist, #RPO, Wausau, San Antonio, Cincinnati, Provider data,

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Posted: 2021-05-17 Expires: 2021-07-15

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Provider Relations Specialist - in Wausau, San Antonio or Cincinnati - 921306

UnitedHealth Group
Wausau, WI 54403

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