The Senior Provider Relations Advocate is responsible for the full range of provider relations and service interactions within WellMed, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training and development of external provider education programs. Senior Provider Relations Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Responsibilities also include directing and implementing strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims.
Assess and interpret customer needs and requirements
Identify solutions to non-standard requests and problems
Solve moderately complex problems and/or conduct moderately complex analyses
Work with minimal guidance; Seek guidance on only the most complex tasks
Translate concepts into practice
Provide explanations and information to others on difficult issues
Coach, provide feedback, and guide others
Act as a resource for others with less experience
Must possess strong organizational skills
Must be able to shift priorities as business needs dictate
Must have strong analytical skills with the ability to create strategic plans and carry out those objectives
Must be able to communicate professionally and effectively with a wide range of individuals to gain partnership and cooperation in the implementation of processes
Independent travel is a component of this position
- 4+ years of provider relations, provider network, and/or primary care practice management experience
- 3+ years of experience with Medicare and Medicaid regulations
- Intermediate level of proficiency with MS Word and Excel
- Ability to travel regionally about 25%
- Undergraduate degree
- Risk adjusted coding and quality measures experience
- Intermediate level of proficiency in claims processing and issue resolution
- MS PowerPoint and Access
- Tableau proficiency
- Exceptional presentation, written, and verbal communication skills
- Ability to work independently and remain on task
- Good organization and planning skills
- Ability to prioritize and meet deadlines from multi-staff members within the department
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)
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team 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.
This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job keywords: provider relations, claims, Medicare, Medicaid, Physician Business Manager, Fort Myers, FL, Florida