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UnitedHealthcare Community Plan of Michigan provider services manager, develops the Home and Community Based Services (HCBS) and In Lieu of Services (ILOS) provider network through recruitment, contracting and retention activities. The provider services manager also works in conjunction with leadership to identify and resolve issues related to provider satisfaction, develops provider education in alignment with contractual requirements and ensures HCBS provider advocates conduct in person provider field trainings.
The Provider Service Manager is accountable for the full range of provider relations and service interactions for HCBS and ILOS providers, 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.
The main objectives of this position are to ensure customer satisfaction, help providers effectively use our services, serve as the provider advocate within UnitedHealthcare and execute highly effective, highly responsive issue resolution and communication.
If you reside in MI, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Demonstrates knowledge of relevant systems, operations, processes and trends
Identifies, analyzes and resolves provider issues
Advocates and communicates provider tools and resources
Supports, recruits and retains network providers
Monitors key claims payment metrics, including inventories, days on hand and pended claims, for timely and accurate payment of claims per contractual requirements
Manages pended claims by identifying potential reasons for pend, mitigation strategies and execution on "fixes"
Manages and provides oversight of service level agreements
Interacts with contracted providers and regulators on claims payment and provider call center issues
Provides program policy oversight, developing scripts and training for call center and developing operating instructions for claims processing
Reviews provider issue resolution tracking database and revises communication to improve or educate providers, staff and other stakeholders
Communicates to director of operations and across the enterprise to the appropriate business segment all provider issues and concerns regarding claims processing and the call center
Enforces and maintains operational policies and procedures
Enables appropriate escalation for all issues
Assists with monthly, quarterly and annual reporting to support compliance with all regulatory requirements
Coordinates communications between UnitedHealthcare and its subcontracted providers
Develops the provider network through recruitment, contracting and retention activities
Develops, implements and manages provider orientation, education, training and servicing activities for UnitedHealthcare's provider network
Oversees the development and maintenance of contracts, forms, materials and other tools related to the provider services team activities
Interacts with local plan leadership and functional teams as well as regional and national resources to meet objectives in developing and supporting the provider network
Researches and develops provider agreements and other contracts and establishes regular contract review
Performs contract and reimbursement support analysis in support of contract negotiations
Monitors provider network for adequate access for member populations
Monitors providers for contract compliance and provides orientation, training and support
Develops and writes provider services materials for manuals, newsletters and direct mailings to providers
Represents UnitedHealthcare at provider meetings, lectures or presentations
Works with providers and internal staff to resolve contract and claims issues and inquiries
Participates in the development and preparation of network provider listings, including print and online provider directories
Participates in the review and analysis of fee schedules and recommends revisions
Plans and coordinates provider meetings, seminars and direct mail activities
Helps develop provider services policies and procedures
Assists in obtaining required credentialing documents from providers
Coordinates with member services and other appropriate functional areas
Develops and generates reports as needed for internal and external needs and statutory and regulatory reporting
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:
3+ years of working in managed health care plan setting
2+ years of customer service/claims experience
Knowledge of local Home and Community Based Service (HCBS) providers
Knowledge of medical coding and provider reimbursement
Broad knowledge of company's operations
Proven ability to effectively monitor quality standards and service levels
Proven ability to manage provider issues to resolution
Demonstrated ability to focus activities toward a strategic direction and develop tactical plans, drive performance and achieve targets
Proven success in provider contracting and servicing
Demonstrated leadership and team development skills
Resides in the State of Michigan
Access to reliable transportation and the ability to travel up to 50% throughout the state
Preferred Qualifications:
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
_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 healt
