Senior Provider Relations Advocate Job Description

Senior Provider Relations Advocate Job Description

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Senior provider relations advocate provides supervision and daily support to the Provider Relations Advocates as they work to support the providers in their region.

Senior Provider Relations Advocate Duties & Responsibilities

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

Sample responsibilities for this position include:

Performs any other duties as requested by Network Development Management, the Senior Vice President of Network development, Market Executive Director and/or the Chief Executive Officer of Peoples Health Network
Accountable for managing provider relationships within the assigned region and a thorough knowledge of the network, providers, and provider groups within that region
Educate our in network providers on the State of North Carolina’s new implementation of UnitedHealthcare’s Community and State Plan
Serves as the primary liaison to providers and is responsible for maintaining positive, productive and informative relationships with plan providers
Educate our in network providers on the UnitedHealthcare’s book of business
Responsibilities also include directing and implementing strategies relating to the development and management of the provider network, identifying gaps in network composition, prioritizing contracting needs, and claim assistance
Duties include network contracting, service and retention of providers, provider onboarding and training
Accountable for resolution of escalated issues related to network providers and enhancing provider experience, measured by NPS
Accountable for monitoring provider network to identify and resolve gaps in network composition
Accountable for resolution of escalated issues related to network providers and enhancing provider experience as measured by NPS

Senior Provider Relations Advocate Qualifications

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

Education for Senior Provider Relations Advocate

Typically a job would require a certain level of education.

Employers hiring for the senior 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, Business, Communication, MBA

Skills for Senior Provider Relations Advocate

Desired skills for senior provider relations advocate include:

Hospital team
CPT and HCPCS coding
EMR
HEDIS
ICD-9
Medicare Risk Adjustment
Network
Provider groups within that region
Providers
Claims processing systems and guidelines

Desired experience for senior provider relations advocate includes:

Must have strong analytical skills to include spreadsheet analysis, and data pointing mapping
The applicant will service providers within the Tulsa, OK, region
Employee will be reporting to the Director out of San Antonio and working with 2 other Sr
Undergraduate degree or 5+ years of related experience
Demonstrated ability to organize and manage multiple ongoing projects within expected timeframes
Must live within the vicinity of this specific career opportunity

Senior Provider Relations Advocate Examples

1

Senior Provider Relations Advocate Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of senior provider relations advocate. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for senior provider relations advocate
  • Partners with physicians and office staff to discuss PH initiatives and ensure that the plan and the practice are working together to ensure plan members receive appropriate care and coordination through the network
  • Ensures providers have access to, understands the benefits of and utilizes PH resources such as Provider Portal and other web-based resources to assist in ensuring all member and provider needs are met
  • Works with practice for maintenance contracting needs including covering agreements, mid-levels and other amendments as determined by Network Development
  • Performs an initial educational orientation for all newly contracted providers, within the first thirty (30) days of participation within the plan if not prior to the effective date, to make the provider and office staff aware of PH's participation requirements and procedures
  • Provides educational updates, at least annually with the providers and office staff on changes within the Provider Reference Guide, annual benefit changes, new prescription drug formulary, formulary changes
  • Maintains current knowledge of offered products and their corresponding benefits along with the goals and objectives of other departments to ensure alignment in the maintenance of the provider network, internally
  • Participates in standing meetings regarding provider reimbursement issues and network development activities as needed, and additional meetings and provider activities as needed after hours or on weekends as needed
  • Identify gaps in network accessibility and determine provider recruitment targets within assigned territories
  • Build/nurture positive relationships between the health plan and providers
  • Assist in efforts to enhance and ease the due diligence process for providers and the transition to an owned clinic
Qualifications for senior provider relations advocate
  • MS OneNote
  • Identify methods and formats for providing education/training, including communications, live presentations, and information provided over the Internet
  • 3+ years of related experience in resolving escalated and/or challenging customer service issues
  • 1+ year of presentation skills utilizing MS PowerPoint, presenting to all levels
  • Must be able to shift priorities as business needs dictate
  • Must have strong analytical skills with the ability to create strategic plans and carry out those objectives
2

Senior Provider Relations Advocate Job Description

Job Description Example
Our company is looking for a senior 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 senior provider relations advocate
  • Provide internal reporting on Quality Program Results- HEDIS/STARS- Revenue Cycle Management/Finance
  • Independently travel across assigned territory to meet with providers to discuss WellMed tools and programs focused on improving the quality of care for our Members
  • Utilize and work with cross functional teams to review data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources
  • Responsible for building and nurturing strong relationships that promote the best in patient care, support to providers and business outcomes
  • Collaborate with teams to assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
  • Collaborates with providers, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts
  • Contribute to design and implementation of programs that build and promote positive relationships between the health plan, providers, practice managers and supporting staff
  • Responsible for ensuring all Network functions are completed timely and accurately
  • Responsible for the full range of Provider Relations and service interactions for providers
  • Responsible for training and development of providers, including hosting and organizing provider forum
Qualifications for senior provider relations advocate
  • Independent travel is a component of this position
  • Risk adjusted coding and quality measures experience
  • MS PowerPoint and Access
  • High school diploma or 4+ years of healthcare/managed experience
  • Medical sales and relationship management experience
  • Develops, fosters and maintains relationships with contracted physicians and their office staff to identify issues, ensure provider adherence to contractual requirements, educate on Peoples Health plan benefits and initiatives, follow-up as needed regarding issue resolution through face-to-face visits, telephonic and electronic correspondence with provider and staff
3

Senior Provider Relations Advocate Job Description

Job Description Example
Our innovative and growing company is hiring for a senior 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 senior provider relations advocate
  • Ensure accurate provider contract loading, perform QA checks to ensure accuracy, confirm providers meet necessary requirements
  • Partner with cross-functional teams to enhance ease of use of physician portal, Wellness Assessment adoption, and future service enhancements for providers
  • Execute training and development of external providers through education programs
  • Collect / synthesize best practices from across a network of provider organizations
  • Accountable for network service and development for mid-level provider accounts for all lines of vision business
  • Responsible for the network development and growth within a given geographic location
  • Support initiatives to manage network costs
  • Work with potential acquisition Providers and Clinic Administrators to provide and gather necessary information
  • Assist in efforts to enhance and ease the due diligence processes for providers and the transition to an owned clinic
  • Communicate professionally, clearly and timely with Providers
Qualifications for senior provider relations advocate
  • Acts as a reliable resource both internally and externally for assistance with clarifying issues related to member benefits, claims resolution, appeal status, provider recruitment, affiliations issues and authorization information
  • Uses all available information to understand customer needs (both practice and PH) and identify opportunities to meet those needs
  • Obtains a complete understanding of customer needs before offering a solution
  • Coordinates with Market Executive and Medical Directors field team staff on initiatives and efforts with each office
  • Reviews accessibility of provider office and appointment availability via “Access to Care” surveys and other methods
  • Identifies and reports on any changes in the provider office including the introduction of new technology, additional services offered, staffing changes, required modifications to on-call and covering agreements and the addition of any physician extenders
4

Senior Provider Relations Advocate Job Description

Job Description Example
Our innovative and growing company is hiring for a senior provider relations advocate. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for senior provider relations advocate
  • Accountable for monitoring network accessibility and remediating gaps
  • Contribute to design and implementation of programs and processes that build / nurture positive relationships between the health plan, providers and practice managers
  • Build relationships with hospitals, providers and internal contacts
  • Build and nurture trusted relationships with high touch and territorial providers in assigned counties for all LOB
  • Establish recurring monthly meetings with assigned high-touch providers to discuss outstanding issues and the appropriate escalation path for resolution
  • Provide supervision and daily support to the Provider Relations Advocates as they work to support the providers in their region
  • Work with the Clinical Team when services that are not offered in the network are requested to facilitate the Single Case Agreement process
  • Ensure all contractual requirements are met when a provider is termed in the network
  • Work with the Education Team to identify topics, develop trainings and schedule opportunities to provide education and technical assistance to the provider network
  • Documents, researches and communicates all provider demographic changes and provider terminations, providing required backup documentation
Qualifications for senior provider relations advocate
  • Maintains an accurate and current weekly schedule of work related activities and reports detailing all visits, calls, meetings, back up documentation, including signed provider service forms and/or Macess EXP service forms (SFs)
  • Responsible for the knowledge, response and resolution of new and continuing issues presented by various areas including Action Items from IPA Boards, Contracts Committee, Regional Markets and the Appeals & Grievances department
  • Intermediate level of proficiency with (MS Word, Outlook, Excel, Email packages), preferred
  • Team lead, guide others, and provide feedback
  • Provider service and issue resolution
  • 3+ years of issue resolution experience
5

Senior Provider Relations Advocate Job Description

Job Description Example
Our company is looking to fill the role of senior provider relations advocate. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for senior provider relations advocate
  • Assist in end-to-end provider claims and other provider service issues
  • Represent UnitedHealth Care at various public events
  • Travel within the state of TX and potentially in Florida to assist in end-to-end provider acquisition efforts within the market
  • Work with internal departments to provide necessary information, but also understand confidential information and guide what is on a need to know basis only
  • Coach, provide feedback and guide others while working with potential target practices
  • Identify gaps in processes and assist acquisition team in process improvement
  • Analyze and interpret Utilization trends to improve overall Performance
  • Partner with internal and external associates to facilitate data exchange
  • Assist with ECG access and navigation
  • Assist Risk Group to enhance ease of use of Physician Portal and future services enhancements
Qualifications for senior provider relations advocate
  • Intermediate level of proficiency in provider claims and issue resolution
  • 3+ years of provider relations and/or provider installation experience
  • Willingness and ability to travel within the state of TX as needed
  • Contribute to the design and implementation of programs that build/nurture positive relationships between the health plan and Risk Group
  • Help implement training and development of Risk Group through education in process and sharing of best practices
  • 5+ Years of Healthcare Care/Managed Care Experience

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