Network Account Manager - Waltham, MA; Montpelier, VT

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards. Primary Responsibilities: Ensure that physicians are contracted at market competitive rates. Ensure that participating physicians are educated about UnitedHealthcare and are satisfied with the relationship. High risk, high visibility physicians. Manage relationships with assigned individual physicians or medical groups paid on a fee-for-service basis. Portfolio of physicians will represent high complex, high profile physicians (i.e. hospital based, general surgery, etc). Facilitate and/or completes financial analysis of all reimbursement rate proposals. Determine network adequacy and recruit new providers to fill in gaps that have been identified. Create and maintain strong working relationships and monitor ongoing activities with: Uniprise relative to claims resolution activities Provider Information Management and the Contract Support Specialists relative to contract load activities Regional Audit and Recovery relative to claims audit activities Work in collaboration with RAR to impact reimbursement policies. Identify provider education opportunities and delivers appropriate training. Coordinate, create and disseminate provider training materials. Act as conduit for education of complex reimbursement policy related issues. Assist in the investigation of suspected incidents of billing fraud and abuse. Assist in the credentialing process. Ensure that the provider directory accurately reflects information about the network. Prepare and facilitate operational meetings with the providers consistent with the Relationship Management guidelines. Utilize the actuarial models to track cost per unit activities. Request/pull ad hoc reports and utilize said reports to perform cost per unit analyses required in the contracting/recontracting process. Contract/recontract based on guidelines outlined in the annual cost per unit budget. Monitor activities related to the contract load process; claims resolution; RAR, EDI, and other provider service issues; and provider appeals. Create general communications pieces for the network. Qualifications: 3+ years in a network management-related role, such as contracting, provider services, purchasing, etc. Bachelor's degree in business, health care management, or related field. In-depth knowledge of Medicare reimbursement methodologies (i.e. Resource Based Relative Value System). Fee schedule development using actuarial models. Utilize financial models and analysis in negotiating rates with providers. Knowledge of claims processing systems and guidelines. Understand and interpret complex information from others including reimbursement policies standards. Multi-task, shifting back and forth effectively between two or more activities or sources of information. Possess good interpersonal skills, establishing rapport and working well with others. Can be relied upon to act ethically. Safeguard confidential information and to adhere to UnitedHealthcare's Code of Conduct and all legal and regulatory requirements. Network outside and inside the organization and build positive strategic relationships with key individuals and groups. Maintain a high level of work quality, focuses on detail, and is dependable in meeting commitments and fulfilling obligations. Experience in fee schedule development using actuarial models. Utilize financial models and analysis in negotiating rates with providers. Understand claims processing guidelines. Perform network adequacy analysis. In-depth knowledge of Medicare reimbursement methodologies (i.e. Resource Based Relative Value System). Problem solving skill: Systematically analyze problems draw relevant conclusions Devise appropriate courses of action Excellent verbal and written communication skills: Speak clearly and concisely Conveying complex, technical information in a manner that others can understand Gather, interpret and communicate policy statements Strong negotiation skills: Gain acceptance from others of a plan or idea Achieve mutually beneficial outcome Ability and willingness to: Calmly and effectively assist customers and represent UnitedHealthcare in a professional manner at all times. Calmly and effectively resolve escalated vendor complaints and problems. Work toward team objectives and work well with others.Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.