Provider Relations Advocate Job Description

Provider Relations Advocate Job Description

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Provider relations advocate provides expert consultation in organizational contracting methodologies and reimbursement methodologies, reimbursement coding, and network configurations and analysis for provider databases to internal, vendor and customer claims systems.

Provider Relations Advocate Duties & Responsibilities

To write an effective provider relations advocate job description, begin by listing detailed duties, responsibilities and expectations. We have included provider relations advocate job description templates that you can modify and use.

Sample responsibilities for this position include:

Develop positive working relationships with provider groups and their staff to assure that providers’ concerns are addressed by the appropriate person(s) in a timely, responsive manner
Documents and/or monitors communication with providers in the designated databases
This position will cover providers from Northern to Southwestern Virginia
This position will cover providers in the Richmond, Virginia, area
This position will cover providers in the Virginia Beach, Virginia, area
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
Supports closing gaps in care for assigned providers
Assist providers with claims issues/inquiries
Educate providers on best billing practices, portal usage, and training opportunities
Communicate with provider offices and their staffs, internal departments, Program Network Integrity, and Provider Network Contract Account Lead

Provider Relations Advocate Qualifications

Qualifications for a job description may include education, certification, and experience.

Education for Provider Relations Advocate

Typically a job would require a certain level of education.

Employers hiring for the provider relations advocate job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Education, Healthcare Administration, Network Management, Medical, Healthcare, Business, Business/Administration, Communication, Associates, Health

Skills for Provider Relations Advocate

Desired skills for provider relations advocate include:

Claim processing systems and guidelines
Dental products/providers
Claims processing systems and guidelines
RUGS
Local provider community
Medicaid Regulations
PPO reimbursement methodologies
Providers
Federally administered programs for veterans and military personnel
Providers’ practice / Hospital team

Desired experience for provider relations advocate includes:

Speak as a UHCCP representative at provider-related functions
Provide administrative, operational, analytic and decision-making support regarding provider contracting, contract deliverables and related matters
Review compliance of contract deliverables
Serve as the grant program expert regarding the program’s mission, goals and objectives
Medicaid experience required as this position will be primarily servicing the Medicaid product
2+ years of provider network experience such as provider relations, contracting, credentialing

Provider Relations Advocate Examples

1

Provider Relations Advocate Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of provider relations advocate. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for provider relations advocate
  • Provider contracting experience preferred
  • Periodically review and/or monitor state and federal bulletins for provider sanctions
  • Evaluate current performance of each assigned practice
  • Identify opportunities for provider and Plan to join forces in achieving targets, such as sponsorship of wellness day, co - branding
  • Ensure all claims based issues are triaged to the appropriate party for claims analysis and resolution
  • The Physician Advocate role will be to support the Community and State line of business in the Sacramento market
  • Position being hired is dedicated to Dental
  • Candidate must possess strong organizational skills
  • Candidate must have strong analytical skills with the ability to create strategic plans and carry out those objectives
  • Must be able to communicate professionally and effectively with a wide range of individuals to gain partnership and cooperation in the implementation of processes
Qualifications for provider relations advocate
  • Advanced written skills, especially with drafting contract documents (including but not limited to terms & conditions, statements of work, attachments, exhibits, amendments), contract / provider related correspondence, provider forms, correspondence with state staff, reports for internal and external distribution
  • Experience in contract and amendment writing and preparation, general understanding of contract documents, contract provisions and language
  • 1+ experience working with claims (i.e., statuses, adjustments)
  • Undergraduate degree or minimum of 5 years of related work experience
  • Must be able to travel up to 50% in Virginia area
  • Ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, ability to understand and interpret complex information from others
2

Provider Relations Advocate Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of provider relations advocate. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for provider relations advocate
  • Regional Provider Education and Training (CME, targeted education opportunities)
  • Identify solutions to non - standard requests and problems.- Solve moderately complex problems and/or conduct moderately complex analyses
  • Be able to act as a lead in the department
  • HCBS / Preventive Service Provider Contracting Support
  • Assist in efforts to enhance ease of use of provider billing system and future services enhancements
  • Provider Advocates in this role are the critical link to membership growth and new business development building and maintaining PCP relationship
  • In this role, you'll be part of a performance driven, fast paced organization that is serving multiple markets
  • Organize and lead provider and Joint Operations Committee (JOC) meetings
  • Serve as a representative of the Optum Idaho product and must be knowledgeable on company and contract plans to effectively serve and facilitate communication
  • Renegotiation
Qualifications for provider relations advocate
  • Bachelor's Degree OR High School Diploma with 3+ years of experience working within the Healthcare field
  • In-depth knowledge of Medicaid and Medicare reimbursement methodology
  • Ability to speak clearly and concisely, conveying -complex or technical information in a manner that others can understand, ability to understand and interpret complex information form others
  • MS Access, MS Office Application
  • Facet experience
  • Undergraduate degree or 2 years equivalent experience
3

Provider Relations Advocate Job Description

Job Description Example
Our company is looking for a provider relations advocate. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for provider relations advocate
  • Assist in efforts to empower providers through use of provider portal, administrative updates and future service enhancements
  • Promote enterprise programs that build / nurture positive relationships between the health plan, providers and practice managers
  • Assist in end-to-end provider claims and help enhance call quality Assist in efforts to enhance ease of use of physician portal and future services enhancements
  • Serve as a representative of the product and must be knowledgeable on company and contract plans to effectively serve and facilitate communication
  • Conduct routine physical quarterly visits to contracted nursing facilities
  • Troubleshoot and problem solve common billing errors
  • Proactively identify opportunities for provider education
  • Participate in events that SNF holds or supports as applicable
  • Build relationships with nursing facility staff
  • Medicaid nursing facility billing knowledge/experience a must
Qualifications for provider relations advocate
  • Undergraduate degree or 1 year of equivalent experience
  • Must reside in state of Washington
  • Must live within a commutable distance and have the ability to travel 75 - 80% of the time within of the location listed for this specific career opportunity
  • Must reside within commutable distance to Oregon
  • Rhode Island on site presence
  • Intermediate level of proficiency with Outlook, MS Word, Excel, PowerPoint, Access and contract database tools & technology
4

Provider Relations Advocate Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of provider relations advocate. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for provider relations advocate
  • Provide support and assistance with peers
  • Maintain positive customer relationships in the SNF industry
  • Reviewing and researching provider claim issues
  • Develop an intimate knowledge of the facility team
  • Primary support of the Medicaid Behavioral Health Network
  • Outreach to provider recruitment targets within assigned territory
  • Actively contribute and work on key departmental initiatives
  • Identify and solve moderately complex problems and contracting needs
  • Coach, provide feedback, and act as liaison between internal and external customers
  • Role supports the VA agreement and relationship on behalf of Optum and partner with the VA lead at UHC
Qualifications for provider relations advocate
  • Strong leadership and collaboration skills as it is necessary to work cross functionally and influence other teams, leadership and internal business partners
  • Ability to work independently within a team and to remain on task
  • Excellent organization and planning skills, including the ability to communicate effectively with various levels of leadership
  • Strong knowledge of business processes that impact contract loading and auditing
  • Familiarity with the Rhode Island Market
  • Undergraduate degree or 2 years of equivalent years of experience
5

Provider Relations Advocate Job Description

Job Description Example
Our growing company is looking to fill the role of provider relations advocate. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for provider relations advocate
  • Direct and implement strategies relating to the management of a provider network
  • Provider relations activity for the free standing skilled nursing facility network in IL
  • Liaison with various IL Health Plan departments
  • Assist in end-to-end on provider claims, provider information updates and help enhance call quality
  • Assist in efforts to enhance ease of use of Provider Connect, MyAvatar and future services enhancements
  • Use data to identify and solve a range of problems for Skilled Nursing Facilities across the State of Georgia
  • Work exclusively with Skilled Nursing Facilities (SNF) and their operational staff
  • Provide explanations and information to others by leading small group meetings
  • Assist in end-to-end provider claims
  • This position is unique to SNF and Primary Care Physicians (PCP)
Qualifications for provider relations advocate
  • Must live within a commutable distance of one of the office locations listed for this specific career opportunity
  • High school diploma or 2 years of equivalent work experience
  • 3+ years of experience working in the healthcare or insurance industry
  • Candidate must reside near Boston, MA
  • Must reside near Sugarland, Houston, Missouri City, Stafford-Texas
  • HCBS experience preferred

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