Senior Provider Service Representative2379079 | San Diego, California

Senior Provider Services RepresentativeOptum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.This is a critical position within the Provider Services Department and a required position within our contract budget. This is a budgeted replacement position that is funded by the ASO contract with the County of San Diego. The position is critical to maintaining the Fee for Service Provider Network that we manage on behalf of the County. This position is responsible for processing the provider applications & contracts, completing the provider credentialing and re-credentialing.The Senior Provider Services Representative role is focused on managing provider networks that support the client base, including hospital, FFS and TERM networks. Responsibilities may include provider relation activities, analyzing provider performance, credential and recredentialed activities, and creating provider reimbursement arrangements. Demonstrates thoroughness and attention to detail to reviewing tasks and documents. Proactively engages in effective communication with diverse audiences and providers. Maintains tasks accuracy especially under tight work deadlines. Consistent with productivity goals and departmental expectations.Responsible for the full range of provider relations and service interactions. Works with Manager of Provider Services on processing applications and related documents; completing credentialing process in conjunction with Corporate Credentialing Department staff. Maintains and ensures the integrity of provider databases; responds to provider inquiries and provides exceptional customer service to providers, County partners, peers, staff in other departments and the general public. The Contract Administrator may work with providers on the TERM, and/or Medi-Cal Fee-For-Service (FFS) Network(s) as well as Off Panel, Out of Network providers, Skilled Nursing Facilities, Hospitals, which includes the San Diego County Psychiatric Hospital and/or Edgemoor Hospital, as well as other medical professionals.Location: This role will require working 2 days onsite at 3131 Camino del Rio North, Suite 700, San Diego CA, 92108. If you reside in San Diego, CA, you will enjoy the flexibility of a hybrid-remote* role as you take on some tough challenges.Schedule: Monday-Friday, 8:30am-5pm PSTPrimary Responsibilities:The role in this function is accountable for the full range of provider relations and service interactions within UHG, focusing on end-to-end provider claims, call quality, and network supportManage provider interactions and ensuring ease of the provider portal, including future service enhancementsSupports the development and delivery of external provider education and training programsAssist the Manager and Leadership in updating and developing provider data, workflows, systems, and other processesSupports credentialing, recredentialing, enrollment and contracting processes, including Letters of Agreement (LOAs) ensuring compliance with NCQA or County standardsOrders and supports Primary Source Verification for ProvidersOversees and maintains updated provider credentialing documentation, including but not limited to DEA registration, clinical license, board certifications, and PLICompletes administrative processes related to the applications and supporting documents to ensure compliance with credentialing criteria for inclusion in the FFS and TERM provider networksCollaborates with cross-functional teams to ensure seamless execution of site-wide processesResponds to provider requests (emails, calls, mail correspondence, and faxes) and inquiries and direct them to appropriate internal or external resourcesDesigns and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managersContributes to the development and management of provider network strategiesIdentifies gaps in provider network composition and services to assist the network contracting and development team in prioritizing contracting needsInvolved in identifying and remediating operational short-falls and researching and remediating claimsFollow up with providers to obtain the necessary supporting documents and attestations required for contracting to maintain their network participationEnsure provider and group system setup forms are accurately completed and submitted to the appropriate internal departments for processingPlans, prioritizes, and organizes and completes tasks to meet established goals and deadlinesDesigns and delivers comprehensive, effective training that aligns with departmental goals and meets the needs of team membersDevelop report templates and generate reports to support provider data analysisActively participates in meetings to support the achievement of departmental and cross-functional goals and objectivesPerform and accurately enter and update provider data across multiple databases used for directories, payments, mailing, and reportingMaintain organized provider files for easy access by staff, leadership, and other departmentsConducts peer review of providers' files to ensure accuracy and current supporting documentsDocument provider communication in designated systems and helps maintain database integrity by verifying and updating provider information during interactionsProvides support to Manager and Leadership in preparation for the annual auditPerforms additional duties as assigned by Manager to successfully support the Department, Leadership, provider networks, and teamWhat are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:Paid Time Off which you start to accrue with your first pay period plus 8 Paid HolidaysMedical Plan options along with participation in a Health Spending Account or a Health Saving accountDental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage401(k) Savings Plan, Employee Stock Purchase PlanEducation ReimbursementEmployee DiscountsEmployee Assistance ProgramEmployee Referral Bonus ProgramVoluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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/GED1+ years of data entry experience1+ years of experience with provider contracting1+ years of experience in the behavioral health managed care environmentIntermediate level of proficiency with Microsoft Office applicationsPreferred Qualifications/Soft Skills:Knowledge of EHR, SmartCareExcellent verbal, written and interpersonal skills required, including experience drafting correspondence and preparing meeting documentationKnowledge of reporting and data analysis requiredFamiliarity with SmartCare or other Electronic Health Record (EHR) systems, or similar platformsSolves moderately complex problems on their own and with the teamWork is frequently completed without established proceduresAbility to work independently and collaboratively in a fast-paced, multi-departmental environmentCapable to act as a resource for othersProactively identifies solutions to non-standard requestsApplies knowledge/skills to a range of moderately complex activitiesHigh level of professionalism and integrityExceptional organizational and time management skillsCommitment to fostering diversity and inclusion across provider networks and organizational practicesStrong focus on achieving measurable results and driving continuous improvementPay 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 hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.At UnitedHealth Group, our mission is