The Provider Contract Specialist serves as the primary liaison between Optum Serve and network providers, helping to strengthen relationships and ensure provider retention. This role identifies and resolves operational issues, addresses provider and customer concerns and responds to customer satisfaction feedback. It also includes researching and resolving accounts payable questions.
The Specialist routinely negotiates cost-effective fees for individual services, verifies provider capabilities and educates providers on contract requirements, processes and documentation. The role requires a strong understanding of customer contractual obligations to accurately translate subcontractor agreements and fee structures for providers. To be successful, the Provider Contract Specialist must be able to assess situations from multiple viewpoints and determine the most beneficial solutions for both Optum Serve and its provider network.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Assess, address and resolve provider concerns by developing and implementing solutions that support both provider satisfaction and customer needs
- Negotiate cost-effective fees, ensuring alignment with provider capabilities and educating providers on complex contract expectations, fee structures, and operational processes
- Interpret provider issues and translate them into actionable guidance for internal operational teams to improve provider support
- Proactively monitor provider compliance, readiness and performance to maintain active network status
- Collaborate closely with scheduling, contracting, claims, credentialing, and operational teams to ensure contractual performance requirements are met
- Manage and resolve complex provider complaints and escalations within tight deadlines while ensuring accuracy and adherence to contractual standards
- Assist in complex end-to-end provider claims processing and resolution, including but not limited to, claims reprocessing, modifying orders, and adhering to contractual guidelines within claim requirements
- Assist in identifying gaps in network composition, services, or provider availability and support network contracting and adequacy teams in addressing these needs
- Support network contracting efforts to ensure effective network adequacy and accessibility metrics across contracts
- Analyze data trends, performance metrics, and operational insights to identify issues, recommend improvements, and collaborate with support teams to resolve non-standard or complex problems
- Serve as a subject-matter resource for less experienced team members and contribute to a positive and collaborative work environment
- Facilitate provider focused discussions, including JOC meetings, on performance trends, expectations, and operational improvement opportunities
- Represent provider perspectives in multi-department forums to help shape process improvements and network strategies
- Manage and prioritize workload effectively to meet deadlines and ensure timely communication with leadership, providers, and partners
- Travel as needed during business hours (up to 10% within 100 miles of assigned territory)
- Perform other duties as assigned
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/GED (or higher)
- 2+ years of experience in provider relations
- Intermediate proficiency with Microsoft Office (Word, Excel, and Outlook) and the ability to navigate multiple web-based applications
Preferred Qualifications:- Experience with medical billing/claims
- Knowledge of medical terminology
- Knowledge or experience negotiating rates and managing subcontractor relationships
- Knowledge of MedNet
- Proven ability to manage provider accounts and support provider retention
- Demonstrated ability to build strong professional relationships within complex business structures
Soft Skills:- Solid independent judgment, accountability, and decision-making skills
- Ability to build rapport and work effectively with healthcare providers
- Excellent organizational and time management skills
- Ability to manage multiple priorities and meet strict deadlines
- Comfortable working under pressure in a fast-paced environment
- Excellent verbal and written communication skills with the ability to convey information clearly and interpret information effectively
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
