Provider Relations Rep. - Mercer Island, WA

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.The Provider Relations Representative will be responsible for managing the ongoing relations, communications and education between the site and the provider in relation to contract administration and claim/billing issues. The includes the collection and maintenance of provider information (demographics), use of EverCare policies and procedures, identification of areas for process improvement, problem resolution including formulating resolution strategies, defining and recommending action items for the site and provider, evaluating outcomes and providing ongoing feedback to appropriate staff. Communications, flexibility, knowledge and credibility are the key drivers of this role in order to establish and sustain the provider relationship, learn about their environment and help them understand how the EverCare program operates. -Establishes and maintains positive long-term provider contract relationships. Establish and facilitate regular operators meetings with key providers (SNFs, PCPs and other as identified). Obtains, records and disseminates updates in provider status that impact contract administration (ex-demographics). Set up adhoc meetings as needed with key or other provider for specific or urgent needs. Coordinates and conducts provider site visits as needed for credentialing purposes. Responds to provider communication including phone, correspondence, bulletins/newsletter, etc -Provides initial and on-going training and education. Establish and maintain initial and on-going provider education (including product, reimbursement, billing requirements and claims). Create and provide ongoing communications and education related to product, provider contract, billing, payment and provider demographics. Serve as a resource to educate providers on appropriate CPT/HCPC/Revenue coding and claims submission. Support and use of EverCare provider materials including: provider manual, communication bulletins. -Facilitates and coordinates process to ensure satisfactory problem resolution. Identify, document and triage provider complaints to appropriate functional areas. Act as key liaison for coordinating billing/payment problem resolution by establishing and supporting processes to resolve issues on a timely basis in conjunction with site staff and/or corporate staff. Key accountability for effective response to conflict resolution to address provider issues or concerns through active listening, communication, and action planning. Conducts on-site trouble shooting and investigation when necessary or requested by provider. -Maintains and disseminates information on the site?s provider network. Maintain and document provider relations including, correspondence, meeting, provider resolution logs, trends and other as appropriate. Maintain SNF specific network directories/vendor lists and site directory Key accountability for creating, maintaining and disseminating Provide Relations Key Customer List database. On-going maintain of accurate and current provider contract demographics forms and termination process. -Develop the necessary knowledge and skills. Solid knowledge and background and support of EverCare and state specific products, policies and programs that impact provider relations and how they vary from standard Medicare. Solid knowledge of EverCare provider contracts including languages and payment methonds. PC skills including basic work, spreadsheet and Windows skills. Knowledge of Cosmos, Q-Star, PDS and other system software as designated. -Develop and complete contracts for designated providers. (percent of time will vary by each EverCare site.) -Handles special projects and other work as assigned. Bachelors degree preferred with 3 years relevant experience or 5 plus years relevant experience in health care industry -Solid written and verbal business communications, organizational and analytical skills; self-motivated and results oriented ability to manage and prioritize multiple tasks, promote teamwork and data based decision-making -Demonstrated skills in conflict/problem resolution. -PC skills including Word, spreadsheet application. -Effective presentation skills for provider training and orientation. -Health plan experience strongly preferred, especially in the areas of member services, provider relations, training, or education, referral authorization, provider contracting and maintenance, or claims processing -Continuous quality improvement experience. -Understanding of Cosmos billing and claims payment.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.