Provider Services Coordinator
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 Coordinator is expected to spend 75% of his/her time working with internal UCare Staff. Address provider issues documented by Provider Service Representatives into timely, effective, and compliant business solutions. Work with various UCare departments to determine root cause of provider problems. Document responses and make changes as appropriate to improve business processes. Specific duties and responsibilities include:
- Research and resolve provider problems. Transform provider business issues, related to but not limited to, credentialing, claims, authorizations and coding into business solutions which are consistent with PRC and UCare policy, procedures and processes. Maintain current and accessible methods of documenting all activities. Coordinate issue resolution with Provider Services staff and communicate resolutions to providers within appropriate time frames.
- Provide ongoing detailed research to support business issues resolution to assigned Provider Services staff and PRC.
- Document, track, and support initiatives and activities related but not limited to Fraud, Waste, and Abuse activities, UCare Network Compliance, UCare Coding Compliance, and other oversight activities as assigned.
- Support the development of material to be used in training sessions and educational programs for providers and staff.
- Lead the internal communication of provider network changes.
- Identify inappropriate coding trends or problems resulting in payment errors and communicate solutions to the appropriate PRC Provider Services staff or Compliance staff.
- Serve as liaison with assigned provider network to support key internal business functions such as directory development, provider credentialing, quality management, utilization management, contract oversight, claims payment and customer service activities.
- Recommend administrative procedures to improve service to providers and enrollees.
- Assist in the development, review, and enforcement of PRC policies, procedures, and processes.
The Provider Services Coordinator position requires at least three years experience in a health care setting. Examples include health plan provider network management department, health plan provider assistance center, physician group practice, or community service agency. Our ideal candidate will have provider services, customer services, and lean project management training. Knowledge of both State Public Programs and Medicare products is strongly preferred, along with knowledge of claims processing and Microsoft software. Bachelor’s degree in health care management or related field required. Related experience will be considered in lieu of a degree.
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.