Director of Provider Contracting - Vision - Multiple Locations

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 Director of Provider Contracting - Vision is responsible for the installation and administration of assigned vision contracts, including, but not limited to: structure and fee schedule reviews, and preparation of plan materials such as the provider manual. Positions are also responsible for overall provider contract and amendment loading and distribution. May include auditing contract loads for adherence to quality measurers and reporting standards.

Primary Responsibilities:


Set team direction, resolve problems and provide guidance to members of own team

May oversee work activities of other supervisors

Adapt departmental plans and priorities to address business and operational challenges

Influence or provide input to forecasting and planning activities

Create/Load/Maintain/Review Provider Contracts

Review provider contracts including the provider manual in order to ensure information is accurate and consistent with guidelines
Communicate identified discrepancies back to contract submitter in order to facilitate corrections of discrepancies
Interpret and/or verify contract language, information, and intent in order to load information into systems properly
Perform audits of new and/or existing provider contracts and fee schedules in order to ensure accuracy
Load contract information or implement updates and amendments (e.g., fee schedule updates, new fee schedules, demographic changes, termination, rate corrections) and coordinate system updates with appropriate areas
Review and/or maintain reports (e.g., metrics, dashboards, spreadsheets) associated with provider contract loading (e.g., turnaround time, number of contracts loaded, accuracy) in order to assess performance, determine potential issues, and/or prioritize workloads (e.g., submissions to be addressed first)
Receive and respond to escalated issues and problems involving contract submissions
Interpret existing contracts in order to identify potential problems or issues needing correction
Collaborate with relevant internal and/or external partners to ensure that data is timely and accurate
Investigate/Research/Resolve Contract Issues and Inquiries

Work with teams to identify needs for a given project or event, work through data analysis/scrubbing requirements
Review structure to ensure contract-loading accuracy
Determine and/or communicate impacts of proposed changes to internal and/or external business partners (e.g., internal departments, providers)
Install corrective changes into appropriate platforms
Identify and/or implement potential long-term, permanent solutions to resolve recurring issues and problems (e.g., training, process changes)
Review recommended or requested solutions and provide appropriate approvals needed to implement corrective solutions
Support Internal and External Business Partners

Provide guidance and direction to internal and/or external business partners on contract processes, issues and/or questions
Prepare, update, and/or share communications and documentation to update internal and/or external business partners on relevant changes and updates (e.g., process changes, corrective solutions)
Work with vendors to communicate amendments or new contracts (ex: printing/mailing, email)
Conduct and/or participate in regular meetings with internal and/or external business partners to share relevant information and discuss changes and updates (e.g., process changes)
Create and/or provide training documents (e.g., loading alerts) to instruct internal business partners on contract procedures
Communicate and/or collaborate with internal business partners to identify process improvement opportunities

Required Qualifications:


Demonstrate Knowledge of Provider Contracting Tools, Processes, and Regulations

2 +years of experience using relevant system applications (e.g., Excel, Access, SharePoint, SalesForce, Docusign)

3 + years of experience working with contract language in order load and maintain contracts properly

3 + years of experience with processes and procedures needed for loading, maintaining, and/or resolving contracts

3 + years of experience using relevant contract auditing tools

2 + years of experience using relevant market rules

3 + years of experience with state and/or federal regulations related to provider contracting (e.g., HIPAA, CMS, state-regulatory agencies)

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is 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.

Job Keywords: Provider Contracts, Installation, Manager, Columbia, Maryland, Indianapolis, IN, and Minneapolis, Minnesota, MN, MD