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Reporting directly to the NC Community (Health) Plan supporting Medicaid and Dual Special Needs programs (DSNP), this Sr. Health Plan Provider Liaison is both self-directed and works as part of a health plan team to liaison with providers across the state, resolving complex operational issues and concerns, as well as supporting the health plan driving highest Net Promotor Score (NPS) and provider satisfaction within the market.
This externally focused position will interact with providers daily, helping both providers and the Health Plan to review and resolve service issues and support providers in their partnership with the Health Plan serving NC Medicaid beneficiaries.
If you are located in North Carolina, you will have the flexibility to telecommute* as you take on some tough challenges.
- Work directly with providers via telephone, video conference and in person, building great relationships and demonstrating the mission and values of our organization working directly with our provider partners
- Demonstrate highest levels of customer satisfaction skills and competencies in supporting various provider types (including FQHCs, Local Health Departments, home health, personal care services, DME, etc.)
- Demonstrate a high degree of resilience, focus and persistence to identify root-cause of issues and see through to resolution, including following-up with provider to ensure their satisfaction with solution
- Working closely with various and often highly specialized internal business partners to help solve for concerns
- Health Plan Provider Liaison must possess an inherent ability to problem-solve complex and often unique issues that may not have a clear path to resolution
- Triage and determine root cause through researching data and claims systems for escalated claims issues impacting a provider's Accounts Receivable
- Work across the enterprise to design and implement solutions to identified trend issues, through reporting, improvements to processing instructions, or other innovations
- Where applicable, determine broader impact of identified root cause issues beyond the provider where the topic was initiated, and work with internal business partners to develop comprehensive solution strategy
- Make recommendations to provider partners to help support their efficiency and quality of their administrative work, where feasible or helpful for provider
- Establish proactive reporting and other initiatives to identify and act on opportunities to minimize provider abrasion while solutions are being implemented
- Conduct live, telephonic and/or web-based meetings with providers to review findings of identified practice gaps by discuss opportunities for UHG and/or the provider to implement changes in the practice to improve the revenue cycle experience, and track progress of each agreed initiative
- May attend and support meetings, via in-person, telephonic and/or web-based interactions, with individual providers and in group settings, such as Town Hall meetings, Joint Operating Committee meetings, Provider Information Expos or Mobile Service Center meetings
- Use appropriate tracking tools and service models to escalate service issues
- Interact with internal network teams and other operational areas where necessary for contract intent clarification, compliance questions, etc.
- Make educational outreach as needed related to request from internal areas such as lines of business contacts, appeals and grievances, etc.
- Provide feedback and guidance to network management regarding administrative compatibility, performance, and opportunities for improvement in contractual agreements
- Engages with enterprise business partners to identify common billing practices and educate provider to reduce office administrative burden and increase operating efficiencies
- Position requires North Carolina travel to meet with providers to ensure highest levels of satisfaction
- Demonstrated competencies and experience working both independently and as part of a team to help achieve health plan goals
- Ability to become a trusted advisor for assigned Provider Accounts through demonstration of our Cultural Values of Integrity, Compassion, Relationships, Innovation, and Performance
- Superior customer service skills with critical thinking skills and confidence to evaluate and develop solutions
- Ability to work within multiple complex technology and enterprise-wide systems
- Ability to prioritize tasks and work independently and effectively under time constraints
- Excellent verbal and written communication skills with the ability to communicate effectively with external providers
- Solid analytical, critical reasoning and organizational skills
- Sound interpersonal skills, establishing rapport and working well with internal partners
- Sound self-management skills, ability to handle rapid change and an affinity for continuous learning
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.
- 3+ years of experience in health plans or provider experience, with a demonstrated focus on training, education, and/or revenue cycle work
- 3+ years of project management expertise
- Basic knowledge of CPT and ICD-10 coding
- Understanding of provider practice management
- Proficiency with MS Office (Outlook, Word, Excel, Power Point)
- Live within commutable distance to Greensboro, Winston-Salem, High Point, or Raleigh, NC
- Undergraduate degree in Health Administration, Business or equivalent combination of education and relevant experience
- Proficiency with MS SharePoint, and customer management software
- Experience with provider billing and claims data knowledge
- Experience with claims platforms or healthcare platforms, particularly those associated with UnitedHealthcare
- Experience working in a capitated/delegated or shared risk environment
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
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 Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy
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.
Job Keywords: Providers, Senior Health Plan Provider Liaison, Community & State, C&S, Piedmont Triad, Raleigh, Greensboro, Winston-Salem, High Point, NC, North Carolina, Medicaid, Dual Special Needs Plan, DSNP, Health Plan, Net Promotor Score, NPS, claims, diagnosis codes, billing codes