Manager, HCBS Provider Services - Remote in MI

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UnitedHealthcare Community Plan of Michigan provider services manager, develops the Home and Community Based Services (HCBS) and In Lieu of Services (ILOS) provider network through recruitment, contracting and retention activities. The provider services manager also works in conjunction with leadership to identify and resolve issues related to provider satisfaction, develops provider education in alignment with contractual requirements and ensures HCBS provider advocates conduct in person provider field trainings.

The Provider Service Manager is accountable for the full range of provider relations and service interactions for HCBS and ILOS providers, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs. May also be involved in identifying and remediating operational short-falls and researching and remediating claims.

The main objectives of this position are to ensure customer satisfaction, help providers effectively use our services, serve as the provider advocate within UnitedHealthcare and execute highly effective, highly responsive issue resolution and communication.

If you reside in MI, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• Demonstrates knowledge of relevant systems, operations, processes and trends
• Identifies, analyzes and resolves provider issues
• Advocates and communicates provider tools and resources
• Supports, recruits and retains network providers
• Monitors key claims payment metrics, including inventories, days on hand and pended claims, for timely and accurate payment of claims per contractual requirements
• Manages pended claims by identifying potential reasons for pend, mitigation strategies and execution on "fixes"
• Manages and provides oversight of service level agreements
• Interacts with contracted providers and regulators on claims payment and provider call center issues
• Provides program policy oversight, developing scripts and training for call center and developing operating instructions for claims processing
• Reviews provider issue resolution tracking database and revises communication to improve or educate providers, staff and other stakeholders
• Communicates to director of operations and across the enterprise to the appropriate business segment all provider issues and concerns regarding claims processing and the call center
• Enforces and maintains operational policies and procedures
• Enables appropriate escalation for all issues
• Assists with monthly, quarterly and annual reporting to support compliance with all regulatory requirements
• Coordinates communications between UnitedHealthcare and its subcontracted providers
• Develops the provider network through recruitment, contracting and retention activities
• Develops, implements and manages provider orientation, education, training and servicing activities for UnitedHealthcare's provider network
• Oversees the development and maintenance of contracts, forms, materials and other tools related to the provider services team activities
• Interacts with local plan leadership and functional teams as well as regional and national resources to meet objectives in developing and supporting the provider network
• Researches and develops provider agreements and other contracts and establishes regular contract review
• Performs contract and reimbursement support analysis in support of contract negotiations
• Monitors provider network for adequate access for member populations
• Monitors providers for contract compliance and provides orientation, training and support
• Develops and writes provider services materials for manuals, newsletters and direct mailings to providers
• Represents UnitedHealthcare at provider meetings, lectures or presentations
• Works with providers and internal staff to resolve contract and claims issues and inquiries
• Participates in the development and preparation of network provider listings, including print and online provider directories
• Participates in the review and analysis of fee schedules and recommends revisions
• Plans and coordinates provider meetings, seminars and direct mail activities
• Helps develop provider services policies and procedures
• Assists in obtaining required credentialing documents from providers
• Coordinates with member services and other appropriate functional areas
• Develops and generates reports as needed for internal and external needs and statutory and regulatory reporting