Provider Services Coordinator - San Diego, CA

Unitedhealth Group Inc. San Diego , CA 92140

Posted 1 week ago

Energize your career with one of Healthcare's fastest growing companies.

You dream of a great career with a great company where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

It's that time, isn't it? You're ready for the next step forward and an opportunity to build on your skills. And it just so happens that there's never been a better time to become a part of the team at UnitedHealth Group. We're driving even higher levels of sophistication in how provider networks are formed and operate. The goal is to improve quality of service while exploring new ways to manage costs. Here's where you come in. You'll use your knowledge of insurance claims and customer service to help create strong relationships with the providers in our networks. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.

As a provider Services Coordinator you will be directly responsible for all provider services support functions in the local market place representing the organization and functioning as a key member of the local field office. Working directly with the local Provider Service Representatives to add maximum value to the IPA physicians. Provider Service Representative in training and able to assume PSR floater role within six months of assuming PSC position.

Primary Responsibilities & Functions:

  • Maximizes the efficiency and effectiveness of the Provider Service Representatives job duties by providing internal support of key functions.

  • Manages all PSR reports and provider analysis requirements for the Executive Director and local market PSR's based on guidelines established, including management of external report generation and distribution.

  • Ensures accurate monthly capitation payments to the providers including management of capitation deducts.

  • Compiles individual provider quality performance incentive information to assure maximum compliance and optimization of provider incentives.

  • Manages external provider education meetings as established in guidelines including but not limited to orientations and office manager meetings.

  • Manages provider contracts, LOAs, and MOUs as deemed appropriate by the Executive Director, including tracking of credentialing and contract documents.

  • Trains with PSR's on their job duties to provide ability to assume PSR role in the future and to provide coverage when PSRs are unavailable (i.e. PTO, sick days, etc).

  • All other assigned administrative functions necessary to support the Executive Director, PSR's and local market office.

Required Qualifications:

  • High School Diploma/GED (or higher)

  • 3 years of experience in a Managed care environment with claims, UM and Credentialing background

  • PC literate with the ability to create, edit, copy, send and save documents, correspondence, and spreadsheets in MS Word and Excel

Preferred Qualifications:

  • Some college or Business/secretarial class work

  • Good understanding of ICD-9, CPT and HCPCS coding

  • Ability to understand and interpret Medical Management and medical claims data

  • Ability to review and interpret contract language/terms

  • Ability to manage multiple projects and tasks at one time

  • Ability to work effectively with provider and ancillary staff, in person and by phone

Soft Skills:

  • Excellent quantitative, organizational and communication skills. Must be multi-tasked

  • Flexible in responsibilities and able to prioritize effectively

  • Maintain organized files

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

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.

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

Keywords: Optum, Optum Healthcare; Provider Services, Customer Service, Coordinator


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Provider Services Coordinator - San Diego, CA

Unitedhealth Group Inc.