Provider Relations Advocate

Primary Responsibilities:

Assess and resolve specific provider concerns, developing and implementing solutions that are beneficial to providers, LHI Customers and LHI
Educate providers on fee structures to ensure collaborative agreement and understanding of LHI Services and the fees associated with them
Staff Provider Relations Telephone Queue, adequately respond to and resolve incoming calls in the appropriate manner
Respond to Customer Satisfaction Surveys and Customer Complaints within the required time frame through investigation and problem solving that results in positive outcomes
Provide explanations and information to others on topics within area of expertise
Proactively review and maintain provider compliance documents to ensure active status within provider network
Collaborate with other departments to assign qualified providers to orders within the contractually allowed mileage radius of the patient's home zip code
Assist in complex end-to-end provider claims processing and resolution, including but not limited to, claims reprocessing, modifying orders, and adhering to contractual guidelines within claim requirements
Ability to resolve complex complaints within strict deadlines while ensuring accuracy and contractual compliance
Assist in efforts to enhance ease of use of physician portal and future services enhancements
Assist in identifying gaps in network composition and services to support network contracting and adequacy teams
Utilize relevant data and facts to analyze and resolve a variety of issues within area of expertise
Investigate and identify solutions to non-standard requests and problems, with some assistance from others
Manage and prioritize work effectively to meet deadlines, ensuring timely responses to leadership, providers, and assigned tasks
Provide explanations and information to others on topics within area of expertise
Use pertinent data and facts to identify and solve a range of problems within area of expertise
Educate providers on a wide range of topics to enhance their knowledge and compliance with policies, procedures, and best practices
Acts as a resource for others with less experience and promotes positive work environment
Coordinate meetings with providers to discuss a variety of topics, including JOC meetings
Attend and contribute to multi-department meetings
Ability to travel as needed
Perform other duties as assigned

Required Qualifications:

High School Diploma/GED
1+ years of experience in provider relations
1+ years of computer proficiency experience with Microsoft Office (Word, Excel, and Outlook) and be able to access multiple web applications
Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Ability to work an 8-hour shift between 8:00 am - 6:00 pm Monday through Friday based upon business needs
Access to reliable transportation and a current and non-restricted state driver’s license and state-required insurance with the ability to travel 10% of the time within 100 miles of territory assigned

Preferred Qualifications:

Knowledge of rates and managing subcontractor relationships
Knowledge of MedNet
Ability to effectively manage provider accounts resulting in provider retention
Ability to develop strong professional relationships while demonstrating a clear understanding of complex business structures
Knowledge of medical terminology

Soft Skills:

Ability to work independently and maintain good judgment and accountability
Demonstrated ability to work well with health care providers
Strong organizational and time management skills
Ability to multi-task and prioritize tasks to meet all deadlines
Ability to work well under pressure in a fast-paced environment
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others