Senior Provider Data Analyst & Resolution Specialist (Remote)

About the role

Optum, part of UnitedHealth Group, is hiring a Senior Provider Data Analyst & Resolution Specialist for its Provider Services Department in San Diego. The position is a budgeted replacement funded by the ASO contract with the County of San Diego and is critical to maintaining the Fee-for-Service provider network managed on the County's behalf. It covers provider applications and contracts, credentialing and re-credentialing, and provider relations. The role is hybrid: two days onsite in San Diego, Monday to Friday 8:30am-5pm PST.

Key responsibilities

• Manage provider interactions and the provider portal, and support external provider education and training programs
• Support credentialing, recredentialing, enrollment and contracting, including Letters of Agreement, in line with NCQA or County standards
• Order and support primary-source verification, and maintain credentialing documentation such as DEA registration, clinical licenses, board certifications and PLI
• Complete administrative processes for provider applications and follow up on supporting documents and attestations needed for network participation
• Respond to provider requests and inquiries and route them to the right resources
• Build and nurture relationships between the health plan, providers and practice managers, and contribute to network strategy and contracting priorities
• Remedy operational shortfalls and claims issues, and prepare for the annual audit
• Enter and update provider data across multiple databases, maintain organized provider files, conduct peer reviews of files and document communications
• Develop report templates, generate reports, train team members and perform additional duties as assigned

Required profile

• 3+ years of experience in healthcare analytics, provider data management, provider relations, claims operations, network management or related healthcare operations
• Experience resolving complex provider issues involving claims, contracting, credentialing, reimbursement and provider data
• Experience analyzing healthcare data and turning findings into actionable business recommendations
• Experience with provider databases and enterprise platforms such as TRES, SmartCare, SharePoint or SQL Server

What we offer

• Paid time off starting from the first pay period plus 8 paid holidays
• Medical plans, dental, vision, life and disability insurance, and a 401(k) savings plan
• Education reimbursement, employee discounts and an employee referral bonus