Software Engineer

About the Role

UnitedHealth Group is a health care and well-being company. Optum is one of its two distinct and complementary businesses.

Key Responsibilities

• Serve as the primary contact for the health plan to resolve all provider servicing issues, including claims, authorization, copies of executed contracts, and provider communication.
• Act as the main point of contact for providers to strategically build relationships and resolve claims, prior authorization, and contract-related issues.
• Manage a portfolio of accounts of HCBS providers to ensure trusting relationships and address issues related to claims, prior authorization, and other identified concerns.
• Work closely with claims Subject Matter Experts (SMEs) to complete sample audits of claims, identify root cause issues, and address related questions.
• Regularly review open items and issues, maintaining a tracking document for timely and accurate resolution.
• Communicate resolutions to providers within 48 hours of receiving notification.
• Monitor the Provider Advocate mailbox daily and answer questions related to claims and other inquiries from HCBS Providers for all atypical services.
• Escalate appropriate issue trends to the Network Director for immediate resolution.
• Use pertinent data and facts to identify and solve problems within the area of expertise.
• Work closely with the LTSS team around prior authorization issues for all HCBS providers.
• Work closely with Clinical Practice Consultants to resolve gaps identified by providers that impact provider network agreements, satisfaction, and burden.
• Work with a manager to resolve gaps identified by providers with the Provider Call Center to ensure provider claims questions are appropriately reviewed and addressed.
• Demonstrate a high level of autonomy by prioritizing and organizing work to meet deliverable deadlines.
• Provide explanations and information to others on topics within the area of expertise.
• Perform outreach and education to providers on policies and procedures.
• Work in partnership with the credentialing team to upload and review credentialing applications for new providers.
• Work in partnership with the national contracting team regarding inquiries or delays with contract execution.

Requirements & Tech Stack

No specific tech stack or technologies mentioned in the raw text for this role.

Qualifications

• Bachelor's degree OR 3+ years of equivalent experience
• 3+ years of provider relations and/or provider network experience, preferably HCBS
• 3+ years of experience with healthcare and managed care / health plans
• Intermediate level of proficiency in issue resolution
• Intermediate knowledge of Medicare and Medicaid guidelines
• Intermediate level of proficiency with MS Word and Excel
• Willing or ability to travel 25%
• Resident of Idaho

Preferred Qualifications

• Proven exceptional presentation, written and verbal communication skills
• Demonstrated ability to work independently and remain on task
• Demonstrated ability to prioritize and meet deadlines from multi-staff members within the department
• Proven good organization and planning skills
• Understanding of the provider data lifecycle (provider contracting, provider data load, provider directory, etc.)