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Careers at UnitedHealth Group

 

We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Network Management

Country:

US

Approximate Salary:

Not Specified

Position Type:

Full Time

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Provider Service Coordinator - Rancho Cucamonga, CA

UHG - RANCHO CUCA, California

Posted: 12/2/2018

Directly responsible for all provider services support functions in the local market place representing the organization and functioning as a key member of the local field office.  Working directly with the local Provider Service Representatives to add maximum value to the IPA physicians. Provider Service Representative in training and able to assume PSR floater role within six months of assuming PSC position.

 

Primary Responsibilities:

  • Maximizes the efficiency and effectiveness of the Provider Service Representatives job duties by providing internal support of key functions
  • Manage all PSR reports and provider analysis requirements for the Executive Director and local market PSR’s based on guidelines established, including management of external report generation and distribution
  • Ensure accurate monthly capitation payments to the providers including management of capitation deducts
  • Compile individual provider quality performance incentive information to assure maximum compliance and optimization of provider incentives
  • Manage external provider education meetings as established in guidelines including but not limited to orientations and office manager meetings
  • Manage provider contracts, LOAs (letter of agreements), and MOUs (memorandum of understanding) as deemed appropriate by the Executive Director, including tracking of credentialing and contract documents
  • Train with PSR’s on their job duties to provide ability to assume PSR role in the future and to provide coverage when PSRs are unavailable (i.e. PTO, sick days, etc)
  • All other assigned administrative functions necessary to support the Executive Director, PSR’s and local market office

Required Qualifications:

  • High School Graduate or GED
  • 3+ years of experience in a Managed care environment with Claims / Utilization Management background
  • PC literate, proficient in Microsoft Word, Excel, Microsoft Outlook, and Power Point
  • Ability to understand and interpret Medical Management and medical claims data
  • Ability to mange multiple projects and tasks at one time
  • Ability to work effectively with provider and ancillary staff, in person and by phone
  • Excellent quantitative, organizational and communication skills.  Must be multi-tasked
  • Flexible in responsibilities and able to prioritize effectively
  • Maintain organized files

Preferred Qualifications:

  • Proficient in Diamond and Crystal Reporting
  • Good understanding of ICD-9, CPT and HCPCS coding
  • Able to review and interpret contract language/terms
  • Bilingual in Spanish & English
  • Credentialing experience


Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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)


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: Provider, Claims, Credentialing, UM, Utlization Management

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