Contract Management Expert - Phoenix, AZ-867821
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
The purpose of this job is to partner with Network and Operations through the contract creation, execution, submission, load, audit and test of facility and ancillary contracts including fee schedules to ensure contract accuracy prior to submission. The Contract Management Expert (CME) will play an active role in supporting critical audits to clarify contract intent and remediation efforts. The CME will also be accountable to manage and submit all contract updates & requirements to Operations on behalf of the Network.
Individuals in this role will be directly accountable for the quality and accuracy of hospital/ancillary contract submissions. This role will also ensure minimal to no rework associated with requirements and intent of the contract through the submission process.
- Manage all hospital/ancillary contracts supported by the Network
- Manage contract maintenance including tracking, calculation of adjustments, creation of payment appendices to support the change, working directly with Healthcare Economics and Operations for review, approval and submission of the contract for installation to systems
- Assist with audits and other quality controls for proactive identification of issues
- Validate contracts before execution to ensure correct templates are used, terms are accurate and ensure executed contracts can be administered across operations (claims, config, eligibility, etc.)
- Manage the claim hold process to minimize claim rework
- Build and maintain relationships with business partners to ensure desired results are attained and maintained
- Actively participate in or lead cross functional teams or projects
- Meet metrics and expectations set by leadership
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.
- High school diploma or GED
- 3 years or more experience in Provider Data Operations, Network Management Contracting, or Provider Relations to include knowledge of business processes that impact facility/ancillary contract loading and auditing
- 3 years or more experience with core Facets platforms
- Self-directed individual with a proven track record of strong organizational skills and ability to adapt quickly to change
- Strong communication skills to clearly and concisely translate complex or technical information for diverse internal audiences
- Proven ability to manage productivity and efficiency in order to visualize and achieve set goals for delivery of contracts for installation
- Intermediate level of proficiency with Microsoft Word / Excel / Outlook / SharePoint
- Strong customer focus with proven ability to anticipate, understand, and meet the needs of internal and external customers
- Exposure to OptumCare Configuration process and workflow tools
- Facets claims experience
- Experience with UHC Secondary Platforms (NICE and PULSE)
- Understanding of facility and ancillary contract reimbursement methodology
- Undergraduate degree in business or healthcare preferred
Building diverse, high quality provider networks is creating greater access to health care and improving the lives of millions. Join us. Learn more about how you can start doing your life's best work.(sm)
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
Job Keywords: Contract Management Expert, Las Vegas, NV, Nevada