UnitedHealth Group Hiring For Senior Provider Services Coordinator – San Bernardino, CA at Hayward, CA Full Time

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.(sm)

This role is directly responsible for all provider services support functions in the local market place representing the organization and functioning as a key member of the local field office. Working directly with the local Provider Service Representatives to add maximum value to the IPA physicians. Provider Service Representative in training and able to assume PSR floater role within six months of assuming PSC position.

Primary Responsibilities:

• Maximizes the efficiency and effectiveness of the Provider Service Representatives job duties by providing internal support of key functions
• Manage all PSR reports and provider analysis requirements for the Executive Director and local market PSR’s based on guidelines established, including management of external report generation and distribution
• Ensure accurate monthly capitation payments to the providers including management of capitation deducts
• Pre-check run review and assist providers with claims concerns
• Compile individual provider quality performance incentive information to assure maximum compliance and optimization of provider incentives
• Manage external provider education meetings as established in guidelines including but not limited to orientations and office manager meetings
• Problem Solve provider and office escalated issues/guidance.
• Manage provider contracts, LOAs (letter of agreements), and MOUs (memorandum of understanding) as deemed appropriate by the Executive Director, including tracking of credentialing and contract documents
• Train with PSRs on their job duties to provide ability to assume PSR role in the future and to provide coverage when PSRs are unavailable (i.e. PTO, sick days, etc)
• All other assigned administrative functions necessary to support the Executive Director, PSRs and local market office

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 Graduate or GED
• 1+ years of experience in a Managed care environment with Claims / Utilization Management and/or background
• PC literate, proficient in Microsoft Word, Excel, Microsoft Outlook, and Power Point
• Intermediate proficiency in Microsoft Excel
• Advanced Outlook Calendar skills for setting up meetings with multiple participants
• Demonstrated ability to understand and interpret Medical terminology and medical claims data
• Demonstrated ability to manage multiple projects and tasks at one time
• Demonstrated ability to work effectively with provider and ancillary staff, in person and by phone
• Ability to maintain organized files

Preferred Qualifications:

• Managed Care or Healthcare industry experience
• Good command of English language, oral and written
• Ability to interact professionally and effectively with all levels of management and providers
• Good understanding of ICD-9, CPT and HCPCS coding
• Able to review and interpret contract language/terms
• Bilingual in Spanish & English
• Credentialing experience
• Excellent quantitative, organizational and communication skills – be multi-tasked
• Flexible in responsibilities and able to prioritize effectively

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. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. 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. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)

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, Claims, Credentialing, UM, Utilization Management, San Bernardino, CA , California