Provider Relations Representative - Santa Clara County

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care.

Join us to start Caring. Connecting. Growing together.

Optum Care Delivery is looking for the best and brightest professionals to handle the business side of medical practice so doctors can be doctors.

We are fortunate to have experienced unprecedented growth in the last few years and we’re just getting started. As the largest Independent Physicians Association in Santa Clara County, not only do we partner with the most health plans, but we’re also the first, and only, Clinically Integrated Network in Silicon Valley.

We deeply trust and value our dedicated physicians and employees who provide compassionate care to our 100,000+ patients every day.

If you are looking for a rewarding opportunity with an innovative, collaborative, and inspirational team, join us at Optum / Physician’s Medical Group of San Jose and help us continue to be trailblazers in the transformation of health care.

Primary Responsibilities :

Under the general supervision of the of Network Operations & Network Operations Manager, the Provider Relations Representative is responsible for building long-term relationships with physicians, ancillary providers, and their staff in a positive and proactive manner to support their understanding and compliance with Physicians Medical Group of San Jose / Excel MSO contracts, policies, and procedures

Adheres to scheduled cadence for touchpoints by ensuring that agreed upon agenda is followed, and action items are documented and tracked through consistent and detailed reporting

Coordinating provider quarterly site visit and other site visits to conduct in-office information distribution, training, and troubleshooting

Position requires Representative to be in the field 50%-60% of the work week

Prepares for and attends external community / town hall meetings, educational talks and community events as required and complete any action items that may arise from those meetings

Maintains awareness of providers interested in further engaging with Optum / Physician’s Medical Group of San Jose for new business opportunities / contracts and on shifting market / competitive dynamics that would impact the IPA.

Perform additional duties as assigned

Service Excellence

Fostering and maintaining proactive, positive relations throughout the provider network by communicating with provider offices through face-to-face visits, letters, telephone calls, faxes, and emails to promote PMG / Excel MSO and share data, information regarding the improvement of the provider’s practice

Effectively identifying, directing and or researching provider operational issues for timely resolution. Manage escalated issues by meeting the client’s expectations with the removal of internal / external obstacles

Assist providers and members with basic inquiries about claims, authorizations, benefits, and other issues. This includes working in conjunction with internal departments and external health plans

Assessing composition of the network, the opportunities for expansion in assigned territories, and the availability of services in the surrounding area to be able to provide a comprehensive overview and understanding of the medical community to both internal and external customers

Assist providers, office staff, and members in navigating Optum / Physician’s Medical Group of San Jose and other health plan websites, as well as any other technical component needed to encourage and reassure them to become self-sufficient

Escalate complex issues per department standards

Interacts positively with all departments

Properly document all calls / contacts as required by department standards

Provider Training and Adherence

New Provider Orientation & Training

Coordinating quarterly site visits and other necessary visits to conduct on-site information distribution, and trouble shooting

Educate Providers on quality measures and incentive programs and how to access these metrics for their practice

Assist in the creation and maintenance of department training materials

Preparing and delivering verbal presentations in a group or one-on-one setting to PMGSJ / Excel network providers and their staff as well as internal personnel

Performs special projects as assigned

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 :

Experience with and / or in-depth understanding of Managed Care

Provider relations experience working with Primary Care and / or Specialists

Experience with client relationship and / or conflict resolution experience

Knowledge of CMS 1500 and UB92 forms

Knowledge of Medical Terminology, CPT & ICD 10 codes

Proven ability to write reports and presentations

Proven ability to handle member information in a confidential manner and always ensures HIPAA compliance

Local travel of 50-60% within Optum / Physician’s Medical Group of San Jose network in Santa Clara County (Mileage reimbursement available)

Office base in San Jose

Preferred Qualifications :

Managed Care experience in areas of customer service, claims payment, claims resolution and / or provider service

Risk Adjustment experience

STARS / HEDIS experience

Solid customer service background

Data analysis

Demonstrate accountability for one’s own actions

Proven attention to detail

Proven to be organized and detail oriented with excellent follow up skills

Proven to be self-motivated and able to work with minimal supervision

Proven to be a self-starter who is deadline and result driven

Proven to be dependable and able to work independently

Proven excellent critical thinking, creative thinking, and problem-solving skills

Proven excellent time management skills and the ability to prioritize work

Proven excellent verbal and written communication skills are a must including ability to communicate clearly and concisely

Proven ability to comprehend detailed and often complex information and reiterate in a comprehensible manner

Proven ability to listen skillfully, collect relevant information, prioritize immediate requests, and identify the current and future needs

California Residents Only : The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.

UnitedHealth Group complies with all minimum wage laws as applicable. 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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.

We believe everyone of every race, gender, sexuality, age, location and income deserves the opportunity to live their healthiest life.

Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere : OptumCare is an 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.