Provider Relations Advocate

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Provider Relations Advocate (2394586)

Provider Relations Advocate - 2394586

Opportunities with Logistics Health Incorporated (LHI), part of the Optum family of business. We’re dedicated to simplifying the logistics of complex workforce health programs with cost-effective solutions and a seamless distribution process. With offices in La Crosse, Wis., a satellite office in Chicago and remote employees throughout the country, we have a variety of rewarding career opportunities for you. Elevate your career as you help us create a healthier tomorrow for everyone and discover the meaning behind Caring.

Connecting. Growing together.

At Optum
, the mission is clear:
Help people live healthier lives and help make the health system work better for everyone.

Optum Serve Health Services (OSHS) is one of three businesses under Optum Serve
. Optum Serve provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well-being of Americans. By joining Optum Serve you are part of the family of companies that makes United Health Group a leader across most major segments in the U.S. health care system.

OSHS specializes in creating and managing health care programs through on-location services, patient specific in-clinic appointments, telehealth assessments, or any combination based on customer need.
OSHS’s customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

The
Provider Relations Advocate
will maintain a successful working relationship between
Optum Serve and network providers through a full range of provider relations and service interactions to ensure provider retention. Identify and remediate operational shortfalls, respond to customer complaints, customer satisfaction surveys and provider questions, and research and resolve accounts payable issues. Routinely negotiate cost effective fees for single services, confirm service capability and educate providers on contract expectations, processes and paperwork.

Comprehend detailed knowledge of customer requirements in order to translate subcontractor agreements, contractual requirements and fee agreements to the providers.
Provider Relations Advocate
must be able to routinely evaluate and analyze the most beneficial solution for
Optum Serve
and our network providers in a variety of circumstances.

Schedule: A 40-hour work week, Monday through Friday, a flexible schedule to be determined by the supervisor upon hire in 8-hour shifts.

Location: Remote Nationwide

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

• Assess and resolve specific provider concerns, developing and implementing solutions that are beneficial to providers, LHI Customers and LHI
• Educate providers on fee structures to ensure collaborative agreement and understanding of LHI Services and the fees associated with them
• Staff Provider Relations Telephone Queue, adequately respond to and resolve incoming calls in the appropriate manner
• Respond to Customer Satisfaction Surveys and Customer Complaints within the required time frame through investigation and problem solving that results in positive outcomes
• Provide explanations and information to others on topics within area of expertise
• Proactively review and maintain provider compliance documents to ensure active status within provider network
• Collaborate with other departments to assign qualified providers to orders within the contractually allowed mileage radius of the patient's home zip code
• Assist in complex end-to-end provider claims processing and resolution, including but not limited to, claims reprocessing, modifying orders, and adhering to contractual guidelines within claim requirements
• Ability to resolve complex complaints within strict deadlines while ensuring accuracy and contractual compliance
• Assist in efforts to enhance ease of use of physician portal and future services enhancements
• Assist in identifying gaps in network composition and services to support network contracting and adequacy teams
• Utilize relevant data and facts to analyze and resolve a variety of issues within area of expertise
• Investigate and identify solutions to non-standard requests and problems, with some…