Network Contractor - Partial Telecommute

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)The Network Contractor develops the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. Network Contractors evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.

The Network Contractor will support a full range of government programs such as Medicare and Medicaid quality bonus programs, quality initiatives and risk arrangements.  The role works in collaboration with Quality and Provider Relations teams as well as Health Plan partners to implement and support such programs through provider engagement, drafting of agreements, and system maintenance to ensure the proper functioning of the programs.

The Network Contractor will also contribute to network analysis and structuring initiatives, including managing aspects of the process from provider communications to addressing appeals and rescind requests.  They will review for network adequacy and assist with any ad hoc system updates.  The role also includes investigating provider issues surrounding termination of contracts as well as provider or member complaints.

Primary Responsibilities:


Strong emphasis on FQHC partnerships; provide timely responses to requests for demographic updates and investigation of issues

Support affordability initiatives through provider education, outreach and tracking

Liaise with Health Plan contacts on provider recruitment and network needs

Provider Data integrity research, analysis and outreach as needed

Research and resolve Capitation-related issues

Analysis of various documents in Excel

Network restructuring initiatives:  network analysis, provider communications, appeals/rescinds

Use pertinent data and facts to identify and solve a range of problems within area of expertise

Investigate non-standard requests and problems, with some assistance from others

Work exclusively within a specific knowledge area

Prioritize and organize own work to meet deadlines

Provide explanations and information to others on topics within area of expertise

Ability to work with multiple computer systems and ability to manage priorities to achieve success

 Data Management for provider information is a key responsibility and requires attention to detail

 

Required Qualifications:


Undergraduate degree

2+ years experience in a network management-related role, such as contracting or provider services, or other related managed-care experience.

Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others.

Intermediate level of proficiency with Microsoft Word, Excel and PowerPoint
Preferred Qualifications:


Knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS).

Experience in fee schedule development using actuarial models.

Strong interpersonal skills, establishing rapport and working well with others.

Strong customer service skills

Experience utilizing financial models and analysis in negotiating rates with providers.

At least an intermediate level of knowledge of claims processing systems and guidelines.

Experience in performing network adequacy analysis.

Proficiency with Microsoft Access
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
Diversity creates a healthier atmosphere: 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.

 
Job Keywords: Provider network, cost performance, trend management, negotiate, medicare, actuarial, financial model, claims processing, NY, New York, New Jersey, NJ, Connecticut, Hartford, CT