Provider Relations Representative - Santa Clara County

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. 

Optum Care Delivery is looking for the best and brightest professionals to handle the business side of medical practice so "doctors can be doctors." We are fortunate to have experienced unprecedented growth in the last few years - and we're just getting started. As the largest Independent Physicians Association in Santa Clara County, not only do we partner with the most health plans, but we're also the first, and only, Clinically Integrated Network in Silicon Valley.

We deeply trust and value our dedicated physicians and employees who provide compassionate care to our 100,000 patients every day. If you are looking for a rewarding opportunity with an innovative, collaborative, and inspirational team, join us at Optum /Physician's Medical Group of San Jose and help us continue to be trailblazers in the transformation of health care.

Primary Responsibilities:  

We are looking for a Provider Relations Representative for Network Operations. In this role you will be responsible for:

• Under the general supervision of the of Network Operations & Network Operations Manager, the Provider Relations Representative is responsible for building long-term relationships with physicians, ancillary providers, and their staff in a positive and proactive manner to support their understanding and compliance with Optum /Physician's Medical Group of San Jose contracts, policies, and procedures
  
• Adheres to scheduled cadence for touchpoints by ensuring that agreed upon agenda is followed, and action items are documented and tracked through consistent and detailed reporting
  
• Coordinating provider quarterly site visit and other site visits to conduct in-office information distribution, training, and troubleshooting
  
• Position requires Representative to be in the field 50%-60% of the work week
  
• Prepares for and attends external community / town hall meetings, educational talks and community events as required and complete any action items that may arise from those meetings
  
• Maintains awareness of providers interested in further engaging with Optum /Physician's Medical Group of San Jose for new business opportunities / contracts and on shifting market / competitive dynamics that would impact the IPA
  
• Perform additional duties as assigned
• Service Excellence
  
  • Fostering and maintaining proactive, positive relations throughout the provider network by communicating with provider offices through face-to-face visits, letters, telephone calls, faxes, and emails to promote PMG / Excel MSO and share data, information regarding the improvement of the provider's practice
    
  • Effectively identifying, directing and or researching provider operational issues for timely resolution.  Manage escalated issues by meeting the client's expectations with the removal of internal/external obstacles
    
  • Assist providers and members with basic inquiries about claims, authorizations, benefits, and other issues.  This includes working in conjunction with internal departments and external health plans
    
  • Assessing composition of the network, the opportunities for expansion in assigned territories, and the availability of services in the surrounding area to be able to provide a comprehensive overview and understanding of the medical community to both internal and external customers
    
  • Assist providers, office staff, and members in navigating Optum /Physician's Medical Group of San Jose and other health plan websites, as well as any other technical component needed to encourage and reassure them to become self-sufficient
    
  • Escalate complex issues per department standards
    
  • Interacts positively with all departments
    
  • Properly document all calls/contacts as required by department standards
    
• Provider Training and Adherence
  
  • New Provider Orientation & Training
    
  • Coordinating quarterly site visits and other necessary visits to conduct on-site information distribution, and trouble shooting
    
  • Educate Providers on quality measures and incentive programs and how to access these metrics for their practice
    
  • Assist in the creation and maintenance of department training materials
    
  • Preparing and delivering verbal presentations in a group or one-on-one setting to PMGSJ/Excel network providers and their staff as well as internal personnel
    
  • Performs special projects as assigned
    

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

Years of post-high school education can be substituted/is equivalent to years of experience

Required Qualifications:  

• Experience with and/or in-depth understanding of Managed Care
• Experience with client relationship and/or conflict resolution experience
• Provider relations experience working with Primary Care and/or Specialists
• Knowledge of CMS 1500 and UB92 forms
• Knowledge of Medical Terminology, CPT & ICD 10 codes
• Ability to write reports and presentations
• Handles member information in a confidential manner and always ensures HIPAA compliance
• Local travel of 50-60% within Optum /Physician's Medical Group of San Jose network in Santa Clara County( Mileage reimbursement available)

Preferred Qualifications:    

• Managed Care experience in areas of customer service, claims payment, claims resolution and /or provider service 
• Risk Adjustment experience
• STARS/HEDIS experience 
• Data analysis
• Demonstrate accountability for one's own actions
• Proven solid customer service background
• Proven excellent critical thinking, creative thinking, and problem-solving skills
• Proven excellent time management skills and the ability to prioritize work
• Proven excellent verbal and written communication skills are a must including ability to communicate clearly and concisely
• Proven attention to detail
• Proven ability to comprehend detailed and often complex information and reiterate in a comprehensible manner
• Proven ability to listen skillfully, collect relevant information, prioritize immediate requests, and identify the current and future needs
• Proven to be organized and detail oriented with excellent follow up skills
• Proven to be self-motivated and able to work with minimal supervision
• Proven to be a self-starter who is deadline and result driven 
• Proven to be dependable and able to work independently

California Residents Only: The salary range for California residents is $56,300 to $110,400 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.    

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.   

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.