Healthcare Provider Network Specialist
4 days ago
At UnitedHealthcare, we're revolutionizing the healthcare experience by creating healthier communities and removing barriers to quality care. Our team is dedicated to making a meaningful impact on the lives of millions of people. If you're passionate about shaping the future of healthcare, we invite you to join us.
Key Responsibilities:- Develop and manage unit cost budgets, target setting, and performance reporting
- Predict emerging customer needs and design innovative solutions to meet them
- Build geographically competitive, broad access, and stable networks that achieve objectives for unit cost performance and trend management
- Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards, and other key process controls
- Ensure network composition includes an appropriate distribution of provider specialties
You'll work closely with our national clinics and hospitals to manage, collect, and analyze provider data, update and load provider data, and resolve escalated issues with clients. Our dynamic environment will challenge you and provide clear direction on what it takes to succeed in your role, as well as offer opportunities for growth and development.
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
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.
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