UnitedHealth Group
Network Provider Consultant - Remote in Nebraska
UnitedHealth Group, Omaha, Nebraska, us, 68197
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.
There comes a point when you're ready to take off the training wheels and start guiding others. If that's where you are today, let's talk about where you can be tomorrow with our leading, global health care organization.
UnitedHealth Group is driving ever higher levels of sophistication in how provider networks are composed and compensated. Everything is open to new ideas and innovation. Here's where you come in. Your expertise in provider networks can help us build in the next phase of evolution. In this role, you'll use your knowledge and analytical skills to help determine how clinical providers group up by specialty and service line. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 5 leader.
If you live in Nebraska, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Perform network analysis and strategy development and implementation
Drive program design and implementation to improve network quality and affordability
Obtain, validate and analyze data as you analyze network availability and access. Recommend utilization or expansion of networks for various products
Review end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements and developing training & development of external provider education programs
Designs and implements programs to build and nurture positive relationships between the health plan, key providers (FQHCs and other key physicians, hospital, ancillary, etc.), and practice managers and services those providers not in-scope for Provider Service teams
Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
May also be involved in identifying and remediating operational short-falls and researching and remediating claims. - Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit. Assists in resolution of State concerns, implements new State regulation as pertains to Network
Handles Network operation functions to meet State requirements, duties include but not limited to: Develops reports to meet State requirements, Member notification process, Access and Availability monitoring, PCP Panel monitoring, PCP transfers, Provider load issues, State Provider file, Encounter submissions
Provides oversight for vendor management for contracted provider networks
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:
5+ years of experience in claims processing, provider data maintenance, contracting or contract loading
5+ years of experience with claims systems
3+ years of experience with contract submission, validation and maintenance
Solid knowledge of business processes that impact facility/ancillary contact loading and auditing
Proficiency with all facility/ancillary contract reimbursement methodologies
Preferred Qualification:
Project management experience
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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.
Caring. Connecting. Growing together.
There comes a point when you're ready to take off the training wheels and start guiding others. If that's where you are today, let's talk about where you can be tomorrow with our leading, global health care organization.
UnitedHealth Group is driving ever higher levels of sophistication in how provider networks are composed and compensated. Everything is open to new ideas and innovation. Here's where you come in. Your expertise in provider networks can help us build in the next phase of evolution. In this role, you'll use your knowledge and analytical skills to help determine how clinical providers group up by specialty and service line. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 5 leader.
If you live in Nebraska, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Perform network analysis and strategy development and implementation
Drive program design and implementation to improve network quality and affordability
Obtain, validate and analyze data as you analyze network availability and access. Recommend utilization or expansion of networks for various products
Review end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements and developing training & development of external provider education programs
Designs and implements programs to build and nurture positive relationships between the health plan, key providers (FQHCs and other key physicians, hospital, ancillary, etc.), and practice managers and services those providers not in-scope for Provider Service teams
Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
May also be involved in identifying and remediating operational short-falls and researching and remediating claims. - Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit. Assists in resolution of State concerns, implements new State regulation as pertains to Network
Handles Network operation functions to meet State requirements, duties include but not limited to: Develops reports to meet State requirements, Member notification process, Access and Availability monitoring, PCP Panel monitoring, PCP transfers, Provider load issues, State Provider file, Encounter submissions
Provides oversight for vendor management for contracted provider networks
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:
5+ years of experience in claims processing, provider data maintenance, contracting or contract loading
5+ years of experience with claims systems
3+ years of experience with contract submission, validation and maintenance
Solid knowledge of business processes that impact facility/ancillary contact loading and auditing
Proficiency with all facility/ancillary contract reimbursement methodologies
Preferred Qualification:
Project management experience
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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.