[Hiring] Sr. Network Pricing Consultant @UnitedHealth Group

Role Description

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Lead Out-of-Network Analyses:
  • Utilize and enhance tools developed within the team (Predictive Models, Non-par Status Reports) to model/report impacts of potential/actual contract terminations
  • Identify, investigate, and resolve discrepancies in spend, law application, and Out-of-Network program applicability
  • Maintain timely processing and tracking of Out-of-Network model requests and communicate with local markets
  • Peer-review Tier 1 models for accuracy
  • Support training initiatives and identify training gaps
  • Support Out-of-Network dispute resolution strategy initiatives associated with Federal No Surprises Act (NSA) and state Surprise Medical Bill (SMB) applicable claims
  • Manage data and lookup resources, integrating updates into models
  • Update models with changes to laws or annual Qualified Payment Amount (QPA) updates
• Produce Ad Hoc Out-of-Network Analyses:
  • Independently produce ad-hoc reports using SQL queries and existing models
• Demonstrate Advanced Out-of-Network Knowledge:
  • Understand state/federal surprise medical bills (SMB) and other Out-of-Network (OON) programs
  • Customize reports using SQL and understand impact on model formulas
  • Assist local pricing during terminations and develop talking points
  • Solve errors and enhance Excel formulas/macros in models
• Demonstrate Advanced Consulting Mindset:
  • Lead complex termination calls, manage Shared Savings Program (SSP) Wrap decisions, and track negotiations
  • Prepare for calls with research and tools to provide recommendations
  • Present confidently and act as a subject matter expert for Out-of-Network (OON)-related questions

Qualifications

• Undergraduate degree or equivalent work experience
• 5+ years of analytical experience in financial analysis, healthcare pricing, network pricing, healthcare economics or related discipline
• Experience optimizing analytical models for performance
• Demonstrated ability to efficiently work with large datasets (e.g., high row-count extracts) optimizing calculations and reducing workbook performance constraints
• Advanced level of proficiency in MS Excel
• Experience in MS Access, SAS and/or SQL
• Intermediate ability to interpret and review financial modeling results to evaluate the financial impact of contract changes and develop forecasts
• Prior presentation experience to internal or external stakeholders or customers
• Demonstrated ability to manage multiple projects simultaneously and meet deliverable deadlines

Requirements

• 3+ years of experience with provider payment methodologies and healthcare products
• Experience with medical coding (CPT, MSDRG, REV, ICD-10, etc.)
• Experience leveraging enterprise-approved AI tools to streamline workflows, automate repetitive tasks, and drive continuous improvement in analytical processes and reporting
• Knowledge of Commercial, Medicare, and Medicaid PPO and HMO revenue and expense, as well as delegation financial modeling
• Power Pivot/Data Model and DAX
• Excellent financial impact analysis, risk management, and data manipulation skills
• Excellent interpersonal, collaboration, negotiation and communication skills
• Ability to research and solve problems independently

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

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.