Healthcare Provider Network Contractor

$58,302 - $114,296/Yr

UnitedHealth Group - Honolulu, HI

Full-time - Mid Level

Remote - Honolulu, HI

5,001-10,000 employees

Insurance Carriers and Related Activities

About the position

As a Healthcare Provider Network Contractor at UnitedHealthcare, you will play a crucial role in developing and supporting provider networks while managing unit cost activities through financial modeling and analysis. This position is integral to enhancing the healthcare experience for millions by ensuring that networks are competitive and accessible, ultimately contributing to the evolution of the healthcare system.

Responsibilities

• Manage unit cost budgets, target setting, performance reporting and associated financial models
• Predict emerging customer needs and develop innovative solutions to meet them
• Help develop geographically competitive, broad access, 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 that network composition includes an appropriate distribution of provider specialties
• Work in conjunction with national clinics and hospitals to manage, collect and analyze provider data, updating and loading provider data and resolving any escalated issues with clients.

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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution