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Job Details

TN C&S Health Plan Provider Relations - Remote


Home Health


Brentwood, Tennessee, United States

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 and start doing your life's best work.(sm)

The TN C&S Health Plan Provider Relations represents government products to build and improve physician, facility and practice satisfaction for the TN C&S Health Plan. This is an internal and external focused position and is responsible for the market and will maximize the providers’ ability to interact with the Health Plan as applicable.

If you are located within the Brentwood, TN area, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Acts as a TN C&S Health Plan “navigational” specialist for internal and external business partners
  • Conduit for provider issues
  • Drives mitigation plans to resolve provider issues globally with a goal of reducing the number of state-level Provider Complaints year 1 year
  • Identify gaps in processes and work with internal Business Partners to resolve
  • Conduct weekly meetings with Provider Advocate team to assist in reduction of Provider Complaints through provider outreach and continued education
  • Provider Education to reduce provider complaints and improve providers’ experience with UnitedHealthcare. Including; common billing practice errors, reimbursement policy, self-service tools, service model support, assist with service fails
  • Work with Appeals & Grievance to ensure high quality and accurate responses sent to Tennessee Department of Commerce and Insurance (TDCI) Provider Complaints and Independent Reviews.
  • Drive providers to the standard process, but supplements and supports providers as necessary
  • Participate in new provider education, training programs such as Quarterly webinars/lunch and learn/telephonic or in person seminar
  • Manage health plan Provider Communications through assistance with UnitedHealthcare Provider Communications/Marketing team
  • Coordination and oversight of complex provider challenges including settlements, contract exceptions, and benefit exceptions as appropriate

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:

  • High school diploma or equivalent experience
  • 3+ years of equivalent experience working with government claim operations or provider relations
  • 3+ years of experience with Medicare and Medicaid regulations
  • Experience working with claims data and inaccurate payments facing out to the provider
  • Knowledge of CPT and ICD-9 / ICD-10 coding
  • Understanding of how a claim is built and paid
  • Intermediate PC skills in MS Word, Excel and PowerPoint

Preferred Qualifications:

  • SharePoint creation and experience with maintenance
  • Participation with state audit deliverables
  • Understanding of practice management operations
  • Solid relationship building skills and highly developed customer focus skills
  • Solid written and verbal communication skills
  • Solid self-management skills, ability to handle rapid change and in affinity for continuous learning

Additional Activities and TN State Contract Requirements

  • Proactive Data mining to source out potential issues and remediate through innovation matrix partners
  • Create Standard Operating Procedure changes and implementation
  • Knowledge of claims processing rules and correlating systems that requires leading change efforts with matrix partners
  • Providing timely state ready response for RFI/ORR/State requests
  • Extensive knowledge of navigating reimbursement policies to reduce provider complaints

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

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

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.