22 days old

Contract Management Expert - Telecommute

Las Vegas, NV 89101 Work Remotely
  • Job Code

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.





Posted: 2020-09-29 Expires: 2020-10-29

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Contract Management Expert - Telecommute

UnitedHealth Group
Las Vegas, NV 89101

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