Network Account Manager - U.S.

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.



UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards. 


 


Job Description:


To ensure that physicians are contracted at market competitive rates. To ensure that participating physicians are educated about UnitedHealthcare and are satisfied with the relationship. High risk, high visibility physicians.


 


Job Responsibilities:


Manages relationships with assigned individual physicians or medical groups paid on a fee-for-service basis. Portfolio of physicians will represent high complex, high profile physicians (i.e. hospital based, general surgery, etc).

Facilitates and/or completes financial analysis of all reimbursement rate proposals.

Determines network adequacy and recruit new providers to fill in gaps that have been identified.

Creates and maintains strong working relationships and monitors ongoing activities with Uniprise relative to claims resolution activities, Provider Information Management and the Contract Support Specialists relative to contract load activities, and Regional Audit and Recovery relative to claims audit activities.

Works in collaboration with RAR to impact reimbursement policies.

Identifies provider education opportunities and delivers appropriate training; coordinates, creates and disseminates provider training materials.

Acts as conduit for education of complex reimbursement policy related issues.

Assists in the investigation of suspected incidents of billing fraud and abuse.

Assists in the credentialing process.

Ensures that the provider directory accurately reflects information about the network.

Prepare and facilitate operational meetings with the providers consistent with the Relationship Management guidelines.

Utilizes the actuarial models to track cost per unit activities.

Request/pull ad hoc reports and utilize said reports to perform cost per unit analyses required in the contracting/recontracting process.

Contract/recontract based on guidelines outlined in the annual cost per unit budget.

Monitors activities related to the contract load process; claims resolution; RAR, EDI, and other provider service issues; and provider appeals.

Creates general communications pieces for the network.



Job Qualifications:


Three to five years in a network management-related role, such as contracting, provider services, purchasing, etc.

Bachelors degree in business, health care management, or related field or equivalent experience.

Strong negotiation skills; the ability to gain acceptance from others of a plan or idea and achieve a mutually beneficial outcome.

In-depth knowledge of Medicare reimbursement methodologies (i.e. Resource Based Relative Value System ).

Experience in fee schedule development using actuarial models.

Ability to utilize financial models and analysis in negotiating rates with providers.

Knowledge of claims processing systems and guidelines.

Ability to perform network adequacy analysis.

Problem solving skill; the ability to systematically analyze problems draw relevant conclusions and devise appropriate courses of action.

Ability and willingness to calmly and effectively resolve escalated vendor complaints and problems.

Ability to gather, interpret and communicate policy statements.

Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others including but not limited reimbursement policies standards.

Ability to multi-task, shifting back and forth effectively between two or more activities or sources of information.

Possesses good interpersonal skills, establishing rapport and working well with others.

Can be relied upon to act ethically, to safeguard confidential information and to adhere to UnitedHealthcare's Code of Conduct and all legal and regulatory requirements.

Networks outside and inside the organization and build positive strategic relationships with key individuals and groups.

Maintains a high level of work quality, focuses on detail and is dependable in meeting commitments and fulfilling obligations.

Ability and willingness to calmly and effectively assist customers and represent UnitedHealthcare in a professional manner at all times.

Ability and willingness to work toward team objectives and work well with others.

In-depth knowledge of Medicare reimbursement methodologies (i.e. Resource Based Relative Value System ).

Experience in fee schedule development using actuarial models.

Ability to utilize financial models and analysis in negotiating rates with providers.

Understands claims processing guidelines.

Ability to perform network adequacy analysis.


Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.