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Contract Management Expert

Optum

This is a Full-time position in Seatac, WA posted April 26, 2021.

Contract Management Expert

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 Contract Management Expert (CME) will partner with Network/Contracting 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 implementation.  Responsibilities also include auditing contract loads for adherence to quality measures and reporting standards.

The CME will play an active role in supporting critical audits to clarify contract intent and remediation efforts.  Individuals in this role will be directly accountable for the quality and accuracy of hospital/ancillary contract configuration and implementation.  This role will also ensure minimal to no rework associated with requirements and intent of the contract through the submission and claims payment audit process. 

Primary Responsibilities:

  • Interpret and/or verify contract language, information and intent in order to load information into systems properly
  • Ensure contract templates can be administered across operations (claims, config, eligibility, etc.)
  • Communicate identified discrepancies to Network/Contracting in order to facilitate corrections of discrepancies
  • Assist with audits and other quality controls for proactive identification of issues
  • Perform audits of new and/or existing provider contracts and fee schedules in order to ensure accuracy of set up (e.g., fee schedule updates, new fee schedules, demographic changes, termination, rate corrections) accurately into appropriate systems (e.g., NDB, COSMOS, FACETS, EVIPS, NICE, PULSE)
  • Review and/or maintain reports (e.g., metrics, dashboards, spreadsheets) associated with provider contract loading and auditing(e.g., turnaround time, number of contracts loaded, accuracy) in order to assess performance, determine potential issues, and/or prioritize workloads (e.g., submissions to be addressed first)
  • Collaborate with relevant internal and/or external partners (e.g., IT, CMS, UHC, vendors) to ensure that data is timely and accurate
  • Manage contract maintenance including tracking, calculation of adjustments, review of payment appendices to support the change, working directly with Network/Contracting and Operations for review.
  • 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.

Required Qualifications:

  • 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
  • Facets configuration and claims experience.
  • Exposure to OptumCare Configuration process and workflow tools

Preferred Qualifications:

  • Experience with Macess Platform.
  • Experience with UHC Secondary Platforms (NDB, COSMOS, NICE and PULSE)
  • Understanding of physician, facility and ancillary contract reimbursement methodology, both Medicare and Commercial products
  • Undergraduate degree in business or healthcare preferred

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

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