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 purpose of this job is to partner with Network Management and CCI through the contract creation, execution, submission, load, audit and test of facility and ancillary contracts including fee schedules. The Contract Management Expert (CME) will support critical reviews to ensure demographic, credentialing and contract accuracy prior to submission. The CME will play an active role through the load and audit process with CCI as well as be accountable to review audit results and participate in post installation activity in relationship to claim audit and maintenance. The CME will also be accountable to manage and submit all Rate Escalator and Chargemaster updates to CCI on behalf of Network Management.
Individuals in this role will be directly accountable for the quality and timeliness of hospital/ancillary contract submissions as well as ensure minimal to no rework associated with the installation of the contract into the applicable claim platforms. Primary Responsibilities:Managing facility / ancillary contracts assigned for both Commercial and Government products, including validation of demographics, credentialing and system accuracy prior to installation in applicable systemsValidate Emptoris contracts before execution to ensure correct templates are used, terms are accurate and ensure executed contracts can be administered in all applicable systemsValidate Non Emptoris contracts before execution to ensure terms are accurate and ensure executed contracts can be administered in all applicable systemsManage rate escalator and Chargemaster maintenance including tracking, calculation of adjustments, creation of payment appendices to support the change, working directly with Network Pricing and Network Management for review and approval and submission of the contract for installation to systems; Ensure timely submission for all rate escalators assignedManage service code maintenance for assigned contracts to ensure contracts are updated within Emptoris as well as working with CCI to ensure appropriate systems are updated to reflect the changesCoordination with quality audit team both pre and post implementation to ensure accuracy of contract loading and claim payment accuracy based on contract intentMinimize claim rework associated with incorrect facility/ancillary contract set upBuild and maintain relationships with Network Management and CCI to ensure results are obtained and maintained
Required Qualifications:Bachelor's Degree or High School Diploma/GED with 2+ years of experience with contract submission, validation and maintenance process2+ years of experience with contract submission, validation and maintenance process2+ years of experience with facility/ancillary contract reimbursement methodology Preferred Qualifications:2+ years of experience working specific to demographic, credentialing and contract detail with CSP FACETS2+ years of experience working specific to demographic, credentialing and contract detail with either of the following systems: NDB, COSMOS2+ years of knowledge of business processes that impact facility / ancillary contact loading and auditing, i.e. CCI process, Emptoris, Navigator2+ years of experience with any of the following: claim processing, contracting, or contract loading Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: NDB, COSMOS, Contract Loading, Minneapolis, MN, Minnesota, Minnetonka
Internal Number: 756362
About UnitedHealth Group
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.