Provider Relations Coordinator

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The Provider Relations Coordinator serves as a liaison between Optum and its provider network, delivering responsive support, issue resolution, and administrative coordination to promote exceptional provider satisfaction and operational efficiency. This role supports the Provider Relations Team by facilitating provider communications, collaborating on provider data and onboarding processes, maintaining network records, and assisting with provider education and engagement activities. The Coordinator plays an integral role in quality improvement initiatives by preparing performance reports, scorecards, meeting materials, and action plan documentation; conducting provider and member outreach; and supporting efforts related to HEDIS, CMS, CAHPS, and other performance measures. Additionally, the position collaborates across departments to address provider concerns, support escalation management, monitor network trends, and contribute to provider growth, retention, and overall network performance.

Primary Responsibilities:

• Service Excellence:
• Serves as a point-of-contact to the physician network and is responsive to physician needs
• Responds timely (within one business day) to provider issues, works with other groups/central departments to resolve issues and updates providers and office staff regularly through to resolution
• Assists the Provider Relations team by researching and resolving issues communicated to Optum by network providers
• Conducts outreach to provider network as needed via e-mail or telephonically to help remediate inquiries and concerns from members submitted through Optum's Patient Service Center
• Supports Provider Relations Escalation process, through appropriate triage of issues to PR Team members, monitoring turnaround times to ensure timely resposne, and participating in provider outreach and issue resolution
• Assists with the review, ongoing tracking and data collection for Optum's providers through the Network Services' onboarding and update processes
• Distributes targeted network communications through email, fax and mail as directed
• Provides administrative support to PRMs and PR Department and participates in special projects as assigned
• Provider Training and Data Management:
• Assists the Provider Relations team in setting up and maintaining provider e-files
• Assists the Provider Relations team in maintaining accurate and timely provider information in Optum databases including, but not limited to, maintaining PRM database
• Ensures that provider offices have a Curo, Optum Pro, and DataCORE 'account' assigned (as applicable) and assists in the resolution of provider questions/issues related to usage of these systems and other practice tools
• Quality Performance:
• Supports quality performance measures (e.g., HEDIS, CMS, CAHPS) by engaging targeted provider practices and members, collaborating on improvement workplans
• Develops and prepares monthly performance scorecards, reports, meeting materials, and action plan documentation to support PRMs' practice performance review discussions, JOMs, performance improvement initiatives and as needed/requested
• Collaborates and aligns strategies with other regional support teams (e.g., Network Services, Population Health, Government Programs)
• Conducts member or provider outreach in support of performance improvement initiatives including data collection, quality gap closures, appointment scheduling, quality education
• Growth and Retention:
• Monitors and identifies trends on membership decline and escalates to leadership as appropriate

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.

Required Qualifications:

• Health plan, managed care organization, medical group physician office, IPA, or related work experience
• Intermediate level of experience with Microsoft Suite
• Experience working within a team-oriented environment
• Proven excellent communication skills