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 Contract Specialist is responsible for managing administrative tasks aligned with the contracting process, as well as providing internal support to Network Contractors. The Network Contract Specialist will create contracts, validate data including provider demographic information and submit load requests to the appropriate internal team. They will also be a key resource to Network Contractors, 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. Primary Responsibilities: Communicating contractual terms with providers Negotiating mutually acceptable agreementsUnderstanding of contract policies to ensure compliance and consistent contracting across the enterpriseEnsuring 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 services2+ years of experience utilizing financial models and analysis in negotiating rates with providers2+ years of experience in performing network adequacy analysisFamiliarity with fee schedule development using actuarial modelsAt least an intermediate level of knowledge of claims processing systems and guidelinesAt least an intermediate proficiency with MS Office suite including Word and ExcelPreferred 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 othersStrong interpersonal skills, establishing rapport and working well with others.Strong customer service skillsCareers 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 90,000+ 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: Network Contract Specialist, network management, contracting, provider services, analysis, San Antonio, TX, Texas
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.