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Healthcare Provider Network Specialist

2 months ago

Wailuku, Hawaii, United States UnitedHealthcare Full time
Job Title: Network Contracting SpecialistJob Overview:

UnitedHealthcare is seeking a skilled Network Contracting Specialist to play a key role in developing and supporting Provider Networks, guiding unit cost management activities, and analyzing financial and network pricing models.

Key Responsibilities:
  • Manage unit cost budgets, target setting, performance reporting, and associated financial models to ensure optimal network performance.
  • Predict emerging customer needs and develop innovative solutions to meet them, driving business growth and improving patient outcomes.
  • Collaborate with national clinics and hospitals to manage, collect, and analyze provider data, updating and loading provider data, and resolving escalated issues with clients.
  • Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards, and other key process controls to ensure compliance and quality.
  • Ensure that network composition includes an appropriate distribution of provider specialties to meet customer needs.
Requirements:
  • 3+ years of experience in a network management-related role, such as contracting or provider services.
  • 2+ years of experience in fee schedule development using actuarial models.
  • 2+ years of experience using financial models and analysis to negotiate rates with providers.
  • 2+ years of experience in performing network adequacy analysis.
  • In-depth knowledge of Medicare Resource Based Relative Value System (RBRVS).
  • Intermediate level of knowledge of claims processing systems and guidelines.
What We Offer:

Competitive hourly rate, comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution.

About UnitedHealth Group:

Our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone deserves the opportunity to live their healthiest life, and we're committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.

Equal Employment Opportunity:

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.