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Job Information

UnitedHealth Group Healthcare Provider Network Consultant - Georgia in Atlanta, Georgia

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

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)

If you are located in State of GA, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Working with care providers primarily FQHCs, RHC, school based clinics and other ancillaries to maintain current rosters, demographics and network status in our systems

  • Performing comprehensive data and contract reconciliations across all platforms

  • Managing change requests and data corrections through to claim payment and directory depiction

  • Maintaining current loading protocols for all provider groups across all products and network strategies

  • Proactively identifying updates that impact claims and initiating member reassignments as needed

  • Assisting with contract negotiations and ensuring that new contract provisions are successfully executed across all platforms and processes

  • Partnering with UHN, the Health Plans and medical groups to sign off on the accuracy of network profiles, and implementing remediation plans for providers with submission / accuracy gaps

  • Assist with provider services concerns.

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:

  • Undergraduate degree or equivalent experience

  • 7+ years in the Health Insurance Industry

  • 5+ years in UHC network contracting, load or audit teams

  • 3+ years data analysis research and/or audit experience within the healthcare industry

Preferred Qualifications:

  • Subject Matter Expert experience

  • Proficiency in MS Excel, Access and PowerPoint

  • Experience in managing cross functional projects and making presentations

  • Experience with relevant platforms (e.g., NDB, COSMOS, Emptoris, Facets, Nice, Pulse, PIMS)

  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidat es prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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: Telecommute, NDB, COSMOS, Emptoris, Facets, Nice, PIMS, data analysis research, audit experience, UHC network contracting, load or audit teams, remediation plans, providers