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The External Provider Relations Representative is responsible for maintaining working relationships with the existing Provider Network. Provides training and education regarding policy and procedures and covered benefits. Provides ongoing support for any issues. May assist with Network Development as needed.
This position reports directly to the Sr. Provider Relations Supervisor - TX
If you are located within San Antonio, TX you will have the flexibility to telecommute* as you take on some tough challenges.
- Assists in the implementation of the Provider Relations Department processes, provider education programs and overall network functions
- Works with the management team to develop and revise the Provider Manual. Assists in ensuring that the manual meets operational, regulatory, and accreditation requirements
- Carries out the site review process (for credentialing and re-credentialing), provider manual documentation for education and training, referral and authorization procedures, and department activities
- Serves as a mode of communication to provider offices
- Assists in meeting organizational goals and objectives
- Acts as the liaison between the provider groups and the plan
- Carries out methods of communication to the providers for changes, revisions, issue resolution, and general notices/updates from the plan
- Attends Provider Relations meetings to determine network access and availability, and meeting the requirements for ongoing membership needs
- Assists with network publication, reports, updates, revision, analysis, and reporting to appropriate internal staff and the Dental Management Committee
- Provides provider training and education manual and processes, documentation, reviews
- Other plan required duties and responsibilities as deemed necessary and appropriate
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.
- High School Diploma or GED
- 2+ years of customer service experience
- Experience in Medicaid managed care
- 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
- Bachelor’s Degree in any related field
- Proficiency in Microsoft Office (PowerPoint, Excel, Word)
- Bilingual or Trilingual (English/Spanish or English/Spanish/French Creole)
- Excellent oral and written communication skills
- Effective analytical problem-solving skills
- Ability to travel extensively
- Ability to deliver presentations (Provider training/education)
- Ability to foster positive, productive working relationships
- Ability to conduct self in an acceptable, professional manner and adhere to ethical standards and confidentiality requirements
- All employees shall meet Compliance/Privacy/ Fraud and Abuse Regulations, and attend a Compliance/ Privacy/ Fraud and Abuse educational training annually, as required by law /MCNA Dental Plans
- All employees shall meet Risk Management Regulations, and attend Risk Management education and training within the first thirty (30) days of employment and as required by law or MCNA Dental Plans; and, for those non-dental in clinical or direct care delivery services, annually thereafter
- All employees if duly licensed in a State and said license is part of the requirement of their position with MCNA Dental Plans, shall maintain in good standing and current state licensure
- All employees are required to maintain confidentiality, protect privacy, comply with PHI regulations, and report violations
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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 at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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 bylower 48 law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.