UnitedHealth Group – Provider Relations Representative – Gainesville, GA

Job title: Provider Relations Representative

Company: UnitedHealth Group

Job description: UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities: • Accountable for ownership of provider claim projects in an end-to-end process, from initial project contact, identification and resolution of claim payment issue, and communication of outcome to project contact • Ability to educate provider on details of UHG reimbursement policies, etc., and related claim issues for the UNET CPM products • Must possess a strong working knowledge of the UNET CPM products with the ability to interpret and apply state specific guidelines, regulations, and mandated benefits • Interact directly with market providers and internal staff in the resolution of claim issues • Maintain ongoing communication with project contacts throughout the project process • Research claims to determine accuracy and identify root cause of any claim payment issues • Ensure consistent quality service to UHG’s providers • Resolve complex issues; support fellow CPMs, providing feedback to Leadership as needed • Respond to written, electronic and phone outreaches within current turnaround times • Resolve escalated issues within current escalation turnaround times • Research, analyze, identify root cause, and coordinate resolution of claim issues with business partners within current turnaround times • Gather information to properly analyze issues. The ability to prioritize, and multi-task effectively is required for success in this position • Work with project contact to gather information, prepare and submit claim projects to the Claims Research Team (CRT) if applicable • Ensure accurate project submission based on the identified root cause • Monitor progress of project and provide periodic updates to project contact • Upon project completion by CRT, audit project results, send rebuttals as necessary • Prepare and send project results to project contact, conduct final project contact call to review project outcome and ensure satisfaction with project results • Work collaboratively with CPM and resolution partners to resolve complex claim reimbursement issues that require additional assistance from other Departments within UHG • Accountable for accurate documentation and routing of issues to appropriate resolution partners. Maintain daily tracking and documentation of all project activities and communications within the CPM application • Complete all communications and follow up activities within established turnaround times • Support and represent CPM on conference calls and special projects as assigned • Schedules and facilitates calls with internal and external customers • Serve as primary point of contact for project submitters in resolution of claims project issues, check status of critical issues. Participate in conference calls with internal business partners to obtain information and improve service • Meet or exceed all productivity, turnaround time, and quality assurance expectations and guidelines • Successfully complete and effectively utilize all required training • Maintain compliance with all Federal/State regulations and UHG policies • Manage all provider types • Manage pro-active and non-proactive referral types • Other duties as assigned

What 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 Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at:

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/GED OR 4+ years of experience in a claims, customer service or provider support role • 1+ years of experience and in UNET CPM claims as follows, as well as current access to UNET: claim payment, history review, and complex adjustment review, manual claim calculations, review provider contract set up and selection • 1+ years of experience and/or demonstrated understanding/knowledge of; • Physician, ancillary and facility contracting methodologies, contract loading and contract interpretation • Physician, ancillary and facility claims, including submission, coding, and processing • 1+ years of experience in medical claims reimbursement • 1+ years of experience in UHG’s processes, systems, and products, including but not limited to: (Unet, NDB, ORS, Knowledge Library/MyCoach, IDRS, EDSS, and ICUE/Care one • 1+ years of experience / knowledge of medical terminology, referral and authorization practices, standard-coding methodologies (CPT, ICD-9, HCPCS and revenue) required related to the UNET CPM lines of business • Intermediate level of proficiency within Microsoft Office; • Excel (Ability to conduct v-lookups, data sorting, filter, pivot tables) • PowerPoint (Ability to review attachments) • OneNote (Ability to review and locate SOP's) • Word (Ability to create and edit documents) • Outlook (Ability to create folders, calendar reminders, manage emails, send/receive) • 1+ years of customer service experience with the ability to handle escalated calls, gain the callers trust, take ownership of caller’s issue, and manage through to resolution

Soft Skills:
• Ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action, ability to research, understand and communicate UHG’s reimbursement policies related to the UNET CPM lines of business, additional lines of business is a plus
• Clear spoken voice and solid communication skills, both verbally and written
• Experience in team interactions and improvement methods/projects
• Ability to work independently and make sound decisions in a fast-paced environment
• Proven ability to manage multiple tasks, prioritize and meet deadlines under a heavy workload
• Excellent follow up, organizational and change management skills

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families, and veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

For more information on our Internal Job Posting Policy, .

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $21.68 to $38.56. The salary range for Connecticut / Nevada residents is $23.94 to $42.40. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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

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: Provider Relations Representative, UNET CPM, E&I Oxford, #RPO, remote, telecommute, work from home, work at home, WFH, WAH, hiring immediately, UHC, #Green

Expected salary:

Location: Gainesville, GA

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