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Provider Relations Coordinator

Company: Optum
Location: Arcadia
Posted on: January 16, 2022

Job Description:

Overview:Responsible for supporting the administrative functions of the provider networks and serving as a resource for the network, department and clinician network liaisons. Support the Provider Relations Manaagers who are responsible for the operations of the provider network(s) in assigned region, and is the direct interface between Optum and the affiliate physician network. This position provides continuous education, support, training and troubleshooting to physicians and their staff. Serve as an interface between the central departments and the Independent Physician Association (IPA) network.Essential Functions:

  • Consistently exhibits behavior and communication skills that demonstrate Optums commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
  • Resolves provider issues by interfacing with Optum central departments (Contracting, Eligibility, Claims and Finance).
  • Reports systemic operational issues to the management team.
  • Coordinates provider outreach for the CCR.
  • Follows up with Payor Contracting department on status of clinicians being added, terminated as well as open / closed panel status based on health plan website and submitted information.
  • Verifies annually the single / dual affiliation status of physicians and follows up when they are not maintaining this status.
  • Serves as a point of contact to central departments for issues related to the network, communicates relevant information from the central departments to the network and provides communications and documents upon request.
  • Makes outreach and follow up phone calls to physician offices related to specific initiatives or meetings (i.e. leadership retreat, RADV audit and AEP meetings).
  • Researches pay for performance discrepancies.
  • Completes Notice of Changes and Preferred Provider Lists ensuring information on these forms are inputted in IDX, Optum Connect, Visual Cactus and health plan websites.
  • Attends and helps prepare adhoc meetings (i.e. office manger HCC training and lunch and learn).
  • Takes minutes for specialty JOC meetings.
  • Assists management in developing a quarterly IPA Bulletin containing articles and announcements for the IPA network.
  • Prepares benefit flyers for primary care physicians with health plan ID numbers.
  • Serves as administrative support for Clinician Network Liaisons on days they are not in the office.
  • Collects bios and pictures for website.
  • Responds timely to CSRs.
  • Delivers incentive and other checks.
  • Responds to and resolves questions or concerns from clinicians or staff in a timely and service-oriented manner.
  • Uses, protects, and discloses Optum patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Performs additional duties as assigned.Education: Minimum: High School diploma, G.E.D. or equivalent Preferred: Associate's or Bachelor's degree (open to new grads!)Experience: Minimum:
    • Over 1 year and up to and including 3 years of experience.
    • Customer service experience.
    • Prior office support experience. Preferred: Over 3 years of experience within healthcare industry.
      • Experience using different portals and applications.
      • Experience working with EMR systems.
      • Knowledge of PIP, IDX, and Touchworks is a plus!
      • Prior experience in a health plan, medical group or IPA setting working with physician networks.Knowledge, Skills, and Abilities:
        • Computer literate.
        • Microsoft Office applications skills (Word, Excel).
        • Good understanding of HMO systems provider reimbursement mechanisms.
        • Knowledge of CPT-4 and ICD-9 coding systems.
        • Excellent verbal and written communication skills.
        • Ability to interface with all levels of management
        • Strong customer service and interpersonal skills.
        • Ability to write letters and articles.
        • Excellent organization skills
        • Able to type 25 wpm.
        • 10-key skills
        • Customer service oriented
        • Filing skills
        • Strong analytical and problem solving skills
        • Ability to work on multiple assignments and manage time effectively
        • Knowledge of medical terminology
        • Detail oriented
        • Demonstrated ability to take initiative, ask questions, and prioritize
        • Capable of working independently as requiredRequirement:Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here youll find incredible ideas in one incredible company and a singular opportunity to do your life's best work. (SM)Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Optum, Arcadia , Provider Relations Coordinator, Other , Arcadia, California

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