Provider Relations Representative jobs in Hawaii

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 

Positions in this function are accountable for the full range of provider relations and service interactions within UHG, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs. May also be involved in identifying and remediating operational short-falls and researching and remediating claims. Generally, work is self-directed and not prescribed.

This role will develop and execute the Chart Retrieval/Chase engagement strategy with key Provider Accounts, identifying and collaborating with key stakeholders of our largest Providers. Leaning on industry knowledge, built relationships and marketing savvy, the role will educate key Provider accounts on the benefits of the Retrieval program to gain alignment and participation. In this work, the role will partner with the UHN Contracting team and OptumHealth to execute the enterprise’s strategy, focusing on the risk adjustment and audit components of the Chart Retrieval/Chase work.

If you are located within the state of Hawaii, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Assist in end-to-end provider claims and help enhance call quality
• Coach, provide feedback and guide others
• Assist in efforts to enhance ease of use of physician portal and future services enhancements
• Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, 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
• Work with less structured, more complex issues
• Serve as a resource to others
• This is a field-based role with occasional on-site visits and meetings with physician groups or hospital systems

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.

Required Qualifications:

• 5 years of health care and/or managed care experience
• 3 years of provider relations and/or provider network experience
• 1 years of experience with Medicare and Medicaid regulations
• Experience working directly with physician groups or hospital systems in the provider community
• Intermediate level of proficiency in claims processing and issue resolution
• Intermediate proficiency with MS Word, Excel, PowerPoint

Preferred Qualifications:

• Capitated/delegated or NICE Platform experience
• Experience with hospital and ancillary claims
• Proven solid presentation skills with experience and comfortability presenting to others

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Hawaii Residents Only: The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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: 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.