Position OverviewThe C&S Long Term Care Division requires this position for servicing the LTC provider network, to include provider contracting, credentialing and re-credentialing, conducting provider relations tasks, providing education, working in the provider portal and EVV (electronic visit verification), providing assistance with claims, ensuring network adequacy and closing gaps where necessary, along with network tracking and reporting. This associate works with the case management staff to assist with network needs for member benefits and services, to include working SCAs and PNRs (Single Case Agreements and Provider Network Requests).
The Sr Provider Relations Advocate services in the capacity of Network Account Manager for managing the Florida SMMC business (Medicaid/Long-Term Care). SR PRAs develop and maintains the provider network (ancillary groups and home and community based service providers), yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management and produces an affordable and predictable product for customers and business partners. SR PRAs evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining solid business relationships with providers, and ensuring the network composition includes an appropriate distribution of Long-Term Care (LTC), Home & Community Based (HCBS)specialties.
Additional Job Information:This position will be located in Miami Florida. The goals of our LTC network team are to manage and carry out the provider network requirements for the Health Plan with the State regulator. Provider Relations, Network and Contracting experience is a must, Microsoft Excel intermediate to advanced level is required due to the needs of network reporting. Microsoft Access basics is a plus. Prefer candidate to have Associate Degree or higher. Experience with provider credentialing applications, contracting and fee tables, claims knowledge, Spanish bilingual is preferred.
If you live in FL, you will have the flexibility to work remotely* as you take on some tough challenges. This position requires 25 - 50% travel in Miami region.
Primary Responsibilities:- Job Scope and Guidelines
- Generally work is self-directed and not prescribed
- Works with less structured, more complex issues
- Serves as a resource to others
- Assesses and interprets customer needs and requirements
- Identifies solutions to non-standard requests and problems
- Solves moderately complex problems and/or conducts moderately complex analyses
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Translates concepts into practice
- Provides explanations and information to others on difficult issues
- Coaches, provides feedback, and guides others
- Acts as a resource for others with less experience
- In this role you will be expected to:
- Apply basic knowledge of provider network functions, ability to work in a fast-paced environment
- Intermediate skill level in Microsoft programs (Teams, Outlook, Word, Excel, PowerPoint) and spreadsheet management Microsoft Access knowledge is a plus
- Ability to take initiative and use problem-solving skills for issue resolution
- Depend minimally on others for instruction, guidance or direction Must be attentive to detail, work with flexibility, and have the capability of multi-tasking to meet deadlines and deliverables
- Possess knowledge in Medicaid and Long Term Care (Home and Community Based) programs
- Must have good communication skills; and the ability to build and retain relationships with Provider/Ancillary providers
- Experience working with Health Plan contracts in compliance with company contract templates to ensure the network composition includes an appropriate distribution of provider specialties
- Display professional work ethics in a structured work environment
- Team environment aptitude, work in partnership with Sr Provider Relations Advocates and interact well with staff in cross-segment departments
- Perform other duties as required
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:- 5+ years working in a network management-related role, such as contracting or provider services
- 3+ years of experience in ancillary/facility/group credentialing, to include knowledge of credentialing requirements for the State of Florida
- 3+ years working with provider/group Medicaid/Long Term Care contracts, claims, credentialing
- 3+ years of experience in performing network adequacy analysis
- Intermediate level of knowledge of Medicaid and Long Term Care reimbursement methodologies
- Intermediate level in Microsoft Word, Excel, PowerPoint, Access
- Proven ability to work in a fast-pace ever-changing environment
- Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others
- Proven solid interpersonal skills, establishing rapport and working well with others
- Proven solid customer service skills
- Driver's License and access to a reliable transportation
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
