UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

There are changes happening in health care that go beyond the basics we hear in the news. People like you and organizations like UnitedHealth Group are driving ever 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 solid customer service orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. As you do, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 5 leader.

Primary Responsibilities:

• Collaborates with Value Based groups to develop and monitor performance for incentives programs and value-based agreement
• Develops strategies for risk groups requiring additional guidance and collaborates with the Revenue Cycle Management & HEDIS/STARS Department representatives and Leaders to implement action plans for education and performance improvement as needed
• Identifies areas of opportunities based on the group’s infrastructure and knowledge. Shares best practices with underperforming groups and or newly established Value-Based groups 
• Responsible for developing and building relationships with all assigned Value Based Groups and facilitates introductions between group and key departments including Finance, Revenue Cycle Management and HEDIS/STARS 
• Coordinates initial onboarding meeting for Value based group and educates on the data shared by the health plan as well the role of each department with which they will interact
• Schedules quarterly Joint Operation Committees with Value Based Groups and provides guidance to each of the participating departments on the level of information that will need to be provided 
• Coordinates with Data Services on implementing the ECG (Electronic Customer Gateway) account- so the Health Plan can share the Financial Data Suite
• Coordinates training with Optum for ASM (Alternate Submission Method) for groups wishing to submit data in this manner
• Escalates areas of concern on behalf of the group to the appropriate departments- Medical Economics, Network Management Services, RCM, Finance, STARS, Accounting
• Shares Electronic Fund Transfer Forms with group and submits then to health plan for future surplus payments
• On a yearly basis- reaches out to all at Risk Value based groups and shares pooling attestation for groups to make reinsurance selection
• Notifies group of any changes to Data Feeds or changes in information within the files as needed

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

This position must be located within a commutable distance of our Miami, FL office. You will work in the office, telecommute and travel within the area as needed.

Required Qualifications:

• High school diploma
• 3 years of health care / managed care experience
• 2 years of provider relations and/or provider network experience
• 1 years of experience with Medicare and/or Medicaid regulations
• Intermediate or higher level of proficiency in claims processing and issue resolution
• Intermediate or higher level of proficiency with MS Word, Excel, PowerPoint, and Access
• Bilingual (English & Spanish)
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

• Undergraduate degree
• General knowledge of HEDIS 
• General knowledge of Medicare Risk Adjustment

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidat es prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time 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.