Provider Services Representative
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota’s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We’re an organization that’s going places. Be part of a team that cares about you, be part of UCare.
The Provider Services Representative is expected to spend 50% of his/her time in travel within Minnesota and Wisconsin to assigned providers and regions. The position will build and maintain positive working relationships through routine face-to-face visits with assigned UCare network providers and serve as value add liaison to providers and internal departments within UCare. Specific duties and responsibilities of this role include:
- Maintain effective business relationships through routine face-to-face communication with participating providers, including care systems, primary care providers, hospitals, ancillary/ specialty providers, counties, and allied providers such as behavioral health, chemical dependency, home care, IV therapy, vision, DME, transportation, and interpreters.
- Problem identification and resolution. Resolve, track, report, and internally coordinate issues that providers have encountered, including but not limited to claims issues, authorizations,credentialling, membership discrepencies, and report delieveries. Maintain current PNM issues log as a method of documenting all activities. Assist in documentation and esclation of key provider issues when necessary. Communicate solutions to providers within appropriate time frames.
- Maintain communication with assigned provider network providers regarding credentialing, compliance, claims, coding, membership and regional market characteristics. Communicate any findings to internal staff to guide the development of programs, policies and procedures that support providers.
- Facilitate and present training sessions and educational programs for providers and staff via group training programs and individual provider meetings. Ensure that providers maintain a solid working knowledge of all UCare products, procedures and guidelines through at least annual trainings and reviews.
- Provide education and training to internal UCare staff as needs are identified and in coordination with the appropriate Assistant Director.
- Work with internal staff to assist in identification, tracking, communciation and esclation of systematic/network wide claims, encounters, credentialling issues.
- Coordinate internal communication of provider network changes.
- Identify inappropriate coding trends or issues resulting in payment errors and develop a plan to resolve these trends. Identify appropriate communications to address claims rejections and denials based on claims data. Deliever training to providers to address key issues raised through prior months PAC call data.
- Serve as liaison with assigned provider network to support key internal business functions such as directory development/accurate provider data, provider credentialing, quality management, utilization management, contract/compliance oversight, claims payment and customer service activities.
- Identify network limitations and make recommendations as appropriate.
- Make annual administrative procedures enhancements to improve service to providers and enrollees.
A Bachelor’s degree in health care management or related field is required. Five years of experience in a health care delivery setting required. Examples include physician group practice, health insurance, HMO or community service agency. Provider Relations experience is preferred.
Knowledge, skills and abilities required for this role include:
- Demonstrated oral, written, and interpersonal communication skills with the ability to interact with multiple levels of provider leadership including physicians.
- Strong conflict management and problem resolution skills.
- Strong organization and documentation skills.
- Highly developed ability to meet provider visit quota’s.
- Superior customer service skills.
- Ability to analyze data and processes.
- Self-starter and ability to take initiative
- Strong presentation skills.
- Demonstrated project management skills.
- Developed regional provider knowledge as demonstrated previous employment or proof of competency.
- Knowledge of both State Public Programs and Medicare products preferred.
- Knowledge of claims processing and Microsoft software preferred.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve. EOE/AA
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You’ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis—just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.