Provider Relations Coordinator - Houston, TX

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.AmeriChoice, a UnitedHealth Group company, is a recognized leader and innovator in providing managed health care solutions to its membership, which includes Medicaid, Medicare and SCHIP recipients.  With over a decade of growth and success, we are poised for continued expansion of our services in this dynamic marketplace. Our commitment to this specialized market makes a genuine difference in the lives of our 1.4 million members. Join us, do rewarding work, and build a great career.   Position Description: This position is responsible for leading provider performance management activities across department lines.   Primary Responsibilities:Champions the use of standard tools and processes to drive specific, measurable improvements in network performance to increase provider satisfaction, improve quality scores, achieve claim excellence and support membership growth initiatives.  Develops and executes performance improvement strategies and special projects that directly impact the operational and financial performance of the health plan. Responsible for increasing EDI rates, reducing claim rejections and adjustments, improving quality scores and encounter data collection, and increasing provider satisfaction. Works collaboratively across functional areas and with VP of Sales & Marketing to support growth and attain superior operational efficiencies to improve payment accuracy and reduce rework. Develops and manages effective action plans and process improvement initiatives that enable the Network Relationship team to meet/exceed performance objectives, operational targets and growth objectives. Identification of key providers to target for performance management. Develop and manage effective provider-specific action plans and process improvement initiatives.  Set goals, monitor progress and manage outcomes. Manages interventions, remediation and provider education.  Promotes use of the provider portal and other self-service applications. Relationship management of key providers.  Conducts provider inservices and educational seminars for key providers as needed to improve performance. Assists with identification of candidates for off-cycle contract remediation; collaborates with UHN for shared agreements.  Reports on results. Establishes/maintains collaborative relationships with local UHN team,  medical management staff and others.  Coordinates network management activities as appropriate. Participates in provider administrative manual review and approval for supported markets.  Participates in the design of market-specific provider training materials. Provides input to National Network regarding impact of Provider Portal enhancements. Coordinates Provider Scorecard reporting with UHN to ensure message consistency. General Administrative and Strategy: Refers claim issues through appropriate channels; support the PCSU service model for issue resolution. Approves projects and adjustments over 365 days old. Defines requirements for provider surveys; reviews results and develops action plan based on survey findings. Provides input as needed regarding network design, priorities and risks from a regulatory perspective. Identifies and communicates critical initiatives; provides input for annual goals/objectives for process improvement initiatives.Qualifications:Associates Degree is required. 3 years of provider relations or providers services experience is required.   Microsoft office basic experience is required. Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.  UnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.