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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Network Contracting and Pricing

Country:

US

Approximate Salary:

Not Specified

Position Type:

Full Time

Network Development Specialist, WellMed - San Antonio, TX

UHG - San Antonio, Texas

Posted: 11/12/2018

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

The Network Development Specialist is responsible for managing administrative tasks aligned with the contracting process. The Network Development Specialist will create contracts, validate data including provider demographic information and submit load requests to the appropriate internal team. They will also be responsible for addressing questions regarding contract language, contract set-up, payment methodology and other processes. Attention to detail, problem solving, and establishing and maintaining strong business relationships are crucial for success in this role.

Responsibilities also include communicating contractual terms with providers and negotiating mutually acceptable agreements, understanding of contract policies to ensure compliance and consistent contracting across the enterprise, and ensuring the network adequacy requirements are met for each provider specialty.



Required Qualifications:
  • Undergraduate degree or related experience
  • 3+ years’ experience in a network management-related role, such as contracting or provider services
  • 2+ years of experience utilizing financial models and analysis in negotiating rates with providers
  • 2+ years of experience in performing network adequacy analysis
  • Familiarity with fee schedule development using actuarial models
  • At least an intermediate level of knowledge of claims processing systems and guidelines
  • At least an intermediate proficiency with MS Office suite including Word and Excel
Preferred Qualifications:
  • In-depth knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS)
  • 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 form others
  • Strong interpersonal skills, establishing rapport and working well with others.
  • Strong customer service skills
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.SM


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.

 

Job Keywords: health care, healthcare, contracting, network management, network development, provider data, contract configuration, Medicare, WellMed, San Antonio, Texas, TX

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