Optum

This is a budgeted replacement position that is funded by the ASO contract with the County of San Diego.. The position is critical to maintaining the Fee For Service Provider Network that we manage on behalf of the County.. The Contract Administrator may work with providers on the TERM, and/or Medi-Cal Fee-For-Service (FFS) Network(s) as well as Off Panel, Out of Network providers, Skilled Nursing Facilities, Hospitals, which includes the San Diego County Psychiatric Hospital and/or Edgemoor Hospital, as well as other medical professionals.. Ability to work a hybrid schedule in office 2-4 days a week from 9am-5pm PST in Sand Diego, CA. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life.

provider services representative

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  <o:p> </o:p> <o:p>  </o:p> This is a critical position within the Provider Services Department and a required position within our contract budget.  This is a budgeted replacement position that is funded by the ASO contract with the County of San Diego.  The position is critical to maintaining the Fee For Service Provider Network that we manage on behalf of the County. This position is responsible for processing the provider applications & contracts, completing the provider credentialing and re-credentialing.  <o:p> </o:p> Responsible for the full range of provider relations and service interactions. Works with Manager of Provider Services on processing applications and related documents; completing credentialing process in conjunction with Corporate Credentialing Department staff. Maintains and ensures the integrity of provider databases; responds to provider inquiries and provides exceptional customer service to providers, County partners, peers, staff in other departments and the general public.  The Contract Administrator may work with providers on the TERM, and/or Medi-Cal Fee-For-Service (FFS) Network(s) as well as Off Panel, Out of Network providers, Skilled Nursing Facilities, Hospitals, which includes the San Diego County Psychiatric Hospital and/or Edgemoor Hospital, as well as other medical professionals.<o:p> </o:p> If you reside in San Diego, CA, you will enjoy the flexibility of a hybrid-remote role as you take on some tough challenges. <o:p> </o:p> Primary Responsibilities:  <o:p> </o:p> <ul type="disc"><li >Completes administrative processes related to the application, credentialing, contacting and re-credentialing of providers<o:p> </o:p> </li><li >Reviews all provider applications and supporting documents to ensure compliance with the credentialing criteria for inclusion in the different networks  <o:p> </o:p> </li><li >Tracks credentialing process and sends provider the completed contract once process is completed <o:p> </o:p> </li><li >Runs reports from provider databases to track credentialing and re-credentialing activities for the variety of provider types<o:p> </o:p> </li><li >Returns the signed fully executed contract to new providers in the FFS and TERM networks<o:p> </o:p> </li><li >Tracks providers’ malpractice insurance, DEA, and licensure renewals to ensures they are current/active<o:p> </o:p> </li><li >Facilitates the resolution of credentialing  issues  and coordinates and completes external and internal termination notification requirements <o:p> </o:p> </li><li >Periodically review state and federal bulletins for provider sanctions; review provider disbarment reports and notify Manager of outcome<o:p> </o:p> </li><li >Attend and participate in meetings to achieve departmental and interdepartmental goals and objectives<o:p> </o:p> </li><li >Triages provider related issues and escalates complex problems when necessary to Manager <o:p> </o:p> </li><li >Respond to claim issues by assessing fee schedule and contract configuration, procedure and diagnosis code questions, review of modifiers and other claim form components, in order to determine payment accuracy<o:p> </o:p> </li><li >Builds and maintains productive relationships with network providers and their administrative staff<o:p> </o:p> </li><li >Monitors clinician compliance with policies and procedures; provides education when necessary<o:p> </o:p> </li><li >Assists with network development and handle follow-up activities<o:p> </o:p> </li><li >Organize provider files which are easily reviewed by staff, credentialing committee and external review bodies <o:p> </o:p> </li><li >Accurately enters and maintains  Provider’s data into multiple databases resulting in accurate provider directories, provider payments, mailing labels and report information<o:p> </o:p> </li><li >Documents communication with providers in the designated databases; assists in managing the integrity of databases by using contacts with providers to verify and update provider files<o:p> </o:p> </li><li >Assume additional responsibilities as assigned<o:p> </o:p> </li><li >Position requires access to the following documents which include Protected Health Information: <o:p> </o:p> </li><ul type="circle"><li >Out of Network and Off Panel Fully Executed Agreements<o:p> </o:p> </li><li >Out of Network and Off Panel Fully Executed Agreement Cover letters<o:p> </o:p> </li><li >HICF 1500 Claim forms<o:p> </o:p> </li><li >Provider Treatment Authorizations<o:p> </o:p> </li><li >Provider rosters of current and former clients<o:p> </o:p> </li><li >Correspondence which may include PHI or PII<o:p> </o:p> </li><li >Outpatient Treatment Progress Reports<o:p> </o:p> </li><li >Claims Appeals Letters from Providers<o:p> </o:p> </li><li >Claims Denial Letters to Providers<o:p> </o:p> </li><li >Subpoenas and Court Orders<o:p> </o:p> </li> </ul> </ul>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. <o:p> </o:p> Required Qualifications: <o:p> </o:p> <ul type="disc"><li >High School Diploma/GED (or higher)<o:p> </o:p> </li><li >4+ years of data entry experience<o:p> </o:p> </li><li >2+ years of experience in managed care credentialing<o:p> </o:p> </li><li >2+ years of experience with coordination of benefits and utilization of multiple groups and resources <o:p> </o:p> </li><li >Intermediate level of proficiency with Microsoft Office products including Excel, Microsoft Word, and Outlook<o:p> </o:p> </li><li >Ability to work a hybrid schedule in office 2-4 days a week from 9am-5pm PST <a > </a>in Sand Diego, CA<o:p> </o:p> </li> </ul>Soft Skills: <o:p> </o:p> <ul type="disc"><li >Ability to multitask<o:p> </o:p> </li><li >Ability to work in a fast-paced environment<o:p> </o:p> </li><li >Ability to manage daily tasks<o:p> </o:p> </li><li >Time management and prioritization skills  </li> </ul>*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.<o:p> </o:p>  <o:p> </o:p>  <o:p> </o:p> California Residents Only:  The hourly range for California residents is  $19.47 to $38.08  per hour .  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.   <o:p> </o:p> <o:p>  </o:p> 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.<o:p> </o:p> <o:p>  </o:p> <o:p>  </o:p> 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. <o:p> </o:p> <o:p>  </o:p> UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.<o:p> </o:p> <o:p>  </o:p> <o:p>  </o:p> #RPO #Yellow

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