There are changes happening in health care that go beyond the basics we hear in the news. People like you and organizations like UnitedHealth Group are driving ever higher levels of sophistication in how provider networks are formed and operate. The goal is to improve quality of service while exploring new ways to manage costs. Here’s where you come in. You’ll use your strong customer service orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. As you do, you’ll discover the impact you want and the resources, backing and opportunities that you’d expect from a Fortune 6 leader.
- Assist in end-to-end provider claims issues Coach, provide feedback and guide others
- Assist in efforts to enhance/train/encourage use of physician portal
- Contribute to design and implementation of programs that build/nurture positive relationships between the IPA, providers and practice managers
- Help implement training and development of external providers through education programs
- Identify gaps in network composition and services to assist network contracting and development teams
In this role, you’ll be part of a performance driven, fast paced organization that is serving multiple markets. You’ll have frequent interactions with senior management and physicians as you communicate about ways to evolve ongoing processes and programs.
- High school diploma or equivalent experience
- 5+ years of health care/managed care experience
- 3+ years of provider relations and/or provider network experience
- Intermediate level of proficiency in claims processing and issue resolution
- Proficiency with MS Word, Excel, PowerPoint
- Undergraduate degree
- 1+ years of experience with Medicare regulations
The health system is moving ahead. You can too as you help us build new levels of provider network performance. Join us. Learn more about how you can start doing your life's best work.(sm)
North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.
The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.
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, issue resolution, education, network, Lake Elsinore, Hemet, Temecula, CA, California