At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
As a Network Program Consultant within the Community & State Payment Appendix Team, you will support the development of the provider network (hospitals, ancillary groups and 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 Program Consultants interpret state and market specific reimbursement methodologies to develop and maintain contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining solid business relationships with applicable stakeholders through processes which deliver transparent and predictable pricing strategies for C&S products. This ensures UHN’s ability to build superior provider networks with minimal business risks.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Develop and maintain facility payment appendix language to support the government program reimbursement strategies
Understand government programs reimbursement strategies for various facility types
Research and collaborate with appropriate business owners to support market needs
Coordinate with business partners such as system configuration and affordability teams and other departments / segments to implement reimbursement and pricing strategies
Respond to requests to support the implementation of successful contracting strategies
Conduct training on standard payment appendices
Educate business partners on reimbursement strategies supporting government programs
Evaluate requests and issues raised from the regional Health Plan, Network Management and HCE Network Pricing staff for potential revisions / enhancements to the standard payment appendices and state specific payment appendices
Assess and interpret customer needs and requirements
Identify solutions to non-standard requests and problems
Solve moderately complex problems and / or conduct moderately complex analyses
Work with minimal guidance; seek guidance on only the most complex tasks
Translate concepts into practice
Provide explanations and information to others on difficult issues
Coach, provide feedback, and guide others
Act as a resource for others with less experience
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:
2+ years of experience in a network management-related role, such as reimbursement operations, contracting, provider services or contract loading
Proven knowledge and proficiency in health care industry and facility contracting process
Experience with Medicaid contracting facility reimbursement methodologies (APR-DRG, MS-DRG, APC, per case, per visit, per unit, per unit via fee schedule, etc.)
Proven excellent verbal and written communication skills
Preferred Qualifications:
1+ years of experience in project management
Excellent organizational skills and the ability to track multiple projects with multiple components
Knowledge of end-to-end contracting activities, from new contract creation to contract executions and storage
Experience in fee schedule development understanding state requirements and regulations
Intermediate level of knowledge of claims processing systems and guidelines
Knowledge of CSP Facets, CLM and/or PAL
Proficiency with PowerPoint and Word
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
UnitedHealth Group
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