HCBS Relations Advocate - New Mexico

Provider Relations Advocate

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This Provider Relations Advocate role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We're building better, more effective provider networks every day. In this role, you'll use your strong customer service orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. As you do, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 5 leader.

If you are located in or within commutable driving distance to Albuquerque, Rio Ranco, Santa Fe, you will have the flexibility to work remotely* as you take on some tough challenges.

Approximately 25% of expected travel within New Mexico. Expectation of working in the office as needed in Albuquerque, NM.

Primary Responsibilities:

• Resolve escalated provider issues related to enrollment, billing, and claims, managing cases through resolution
• Conduct ongoing provider education and training sessions in both virtual and in?person settings
• Serve as a subject matter expert for HCBS providers, including but not limited to ABCB, SDCB, EPSDT, Assisted Living, and Home Health
• Support enhancements to the provider portal and contribute to future service improvements
• Conduct annual provider audits, both virtual and onsite
• Assist in the design and implementation of programs that strengthen collaboration between the health plan and provider community
• Support the development and ongoing management of provider networks
• Identify network gaps and service needs, providing insights to contracting and network development teams to support recruitment strategies
• Build and maintain strong provider relationships to promote open communication and awareness of provider and member needs
• Collaborate with internal stakeholders to identify provider challenges and develop solutions
• Escalate issues to leadership as appropriate to ensure timely resolution for providers and members
• Support providers with Electronic Visit Verification (EVV), including AuthentiCare, billing inquiries, care coordination, UHC Provider Resources and Turquoise Care requirements

Are you ready for a challenge? You'll be part of a performance driven, fast paced organization that is serving multiple markets and you'll be charged with educating and building relationships with providers to evolve ongoing processes and programs.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 Diploma/GED
• 2+ years of experience in health care or managed care
• 2+ years of provider relations and/or provider network experience
• 2+ years of experience with Medicare and Medicaid regulations
• Intermediate level of proficiency in claims processing and issue resolution
• Intermediate level of knowledge with Medicaid HCBS programs
• Position requires approximately 25% business travel within New Mexico
• Access to reliable transportation and valid US driver's license

Preferred Qualifications:

• Undergraduate degree
• Proficiency with Microsoft Office tools (Excel, Word, PowerPoint)
• Familiarity with EVV systems or compliance oversight
• Experience working with state agencies or managed care organizations

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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