Facility/Ancillary Contract Management Expert -- Telecommute at Basking Ridge

Job Description

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 lifes best work.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. Responsibilities include:-Managing facility/ancillary contracts assigned for both Commercial and Government products, including validation of demographics, credentialing and system accuracy prior to installation in applicable systems.-Validate Emptoris contracts before execution to ensure correct templates are used; terms are accurate and ensure executed contracts can be administered in all applicable systems.-Validate Non Emptoris contracts before execution to ensure terms are accurate and ensure executed contracts can be administered in all applicable systems.-Manage rate escalator and chargemaster maintenance including tracking, calculation of adjustments, and 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 assigned.-Manage 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 changes.-Coordination with quality audit team both pre and post implementation to ensure accuracy of contract loading and claim payment accuracy based on contract intent.-Minimize claim rework associated with incorrect facility/ancillary contract set up.-Build and maintain relationships with Network Management and CCI to ensure results are obtained and maintained.

Job Requirements

Requirements:- Experience with provider contract load and audit role.- Experience in claims processing, provider data maintenance, contracting, or contract loading.- Intermediate level of proficiency with all facility/ancillary contract reimbursement methodologies.- Experience with claims systems.- Strong knowledge of business processes that impact facility/ancillary contact loading and auditing.- Experience with contract submission, validation and maintenance.- Excellent communication skills required including ability to communicate effectively with various levels of leadership- MS Office (Excel). Undergraduate degree or equivalent experience.UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.Together, we are removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.
Country: USA, State: New Jersey, City: Basking Ridge, Company: UnitedHealth Group.