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Optum Outpatient Behavioral Health Contracting - Telecommute in Washington State

Company: UnitedHealth Group
Location: Seattle
Posted on: August 7, 2022

Job Description:

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 more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This Outpatient Behavioral Health Contracting role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. We re building better, more effective provider networks every day. In this role, you ll use your strong contracting experience to build and maintain our behavioral health provider networks. As you do, you ll discover the impact you want and the resources, backing and opportunities that you d expect from a Fortune 5 leader.

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

Primary Responsibilities:

  • Telecommute position and ideally will reside in Washington State. Some minor travel in Washington State (both Eastern and Western Washington State) will be required. Must have COVID card documenting COVID vaccinations are complete prior to hire.
  • Serve as the subject matter expert for Medicaid, Medicare and commercial outpatient behavioral health provider/agency/group contracting in the states you are assigned including Washington State
  • Conduct provider outreach for outpatient behavioral health provider/agency/group network expansion
  • When interacting with providers, manage provider expectations about timelines for contracting, credentialing, reimbursement levels and methodology, site audits, and the like
  • Develops and maintains positive relationships with external (e.g., behavioral health providers, behavioral health groups, behavioral health agencies/community mental health agencies/federally qualified health clinics, tribal government and other tribal organizations, government agencies) and internal customers
  • Assemble provider agreements consisting of base agreements, appendices and addendums, fee schedules and related documents
  • Issue provider applications, agreements and related documents to providers
  • Gather completed provider applications and other documents that accompany the application, other documents required by state law and/or company policy; review these documents for completeness, accuracy, organize, and submit documents for credentialing
  • Coordinate and follow-up with Optum Provider Relations Advocates to ensure timeliness of submission of applications and related documents
  • Continually Engaged; promptly responds to external and internal customer inquiries; responsible for remaining engaged with external and internal customers until the job is complete; responsible for proactively keep external and internal customers updated about status of requests; communicating with external and internal customers via phone and email and using each appropriately to develop strong working relationships, this includes being prepared for scheduled calls with customers and writing professional communications.
  • Actively participate in Western Region Outpatient Behavioral Health Contracting Team Meetings
  • Serves as a positive member of the internal network team community
  • Team player; Always willing to step-up and help team members as appropriate; respectful of team members and chain of command
  • Understand health plan provider contracts and contract language, terms and conditions and occasionally review provider s proposed language changes and occasionally draft counter language for review by supervisor and legal counsel)
  • Models personal responsibility, dependability, reliability and flexibility in being able to meet the needs of the team and business; accepts responsibility and accountability for actions
  • Continually learns and retains/absorbs knowledge, information and skills to perform the position as you work independently
  • Models integrity and honesty; behaves in an honest, fair, and ethical manner; if says work is complete, it truly is complete and accurate according to standards. Takes the higher road when it comes to conflict.
  • Models stewardship of recourse and documents; is efficient and effective with use of work time; archives and saves fully executed agreements, current fee schedules and related documents in appropriate locations; responsible with public (Medicaid and Medicare) and private funds when negotiating reimbursement in provider agreements
  • Significant hands-on experience with behavioral health provider contracting in the WA State Medicaid market that demonstrates a history of success with WA Medicaid:
    • payment methodologies,
    • rates,
    • geographic service areas/BH-ASO regions
    • fee schedules,
    • payment appendices,
    • providers, behavioral health agencies, and groups,
    • WA State Office of Insurance Commissioner filing / deeming requirements,
    • WA State Health Care Authority review and approvals, and the other dynamics and factor at play,that are truly unique to the WA Medicaid market
    • Report to the Director of Outpatient Behavioral Health Contracting of the Western US
    • Keep Director of Outpatient Behavioral Health Contracting of Western US and Senior Outpatient Behavioral Health Contracting Manager Updated on timely basis about provider network development, contracting developments, rate negotiations, rate increase requests, emerging issues and the like
    • Ability to learn and use proprietary and other software programs for sending, updating and storage of provider/agency/group contracts and numerous fee schedules and related contractual documents
    • Develop, update and maintain numerous fee schedules
    • Actively participate in joint Provider Relations - Outpatient Behavioral Health Contracting Meetings to ensure continuity of communication and coordination between
    • Email and phone communication with internal and external customers throughout each day
    • Ability to work in fast-paced work environment with multiple competing priorities and people from multiple functions within company and multiple external customers and ability to re-prioritize as work and customer deadlines and demands change throughout day and week
    • Exceptional verbal (telephone, video conferencing and in-person) and written communication skills (emails, memos and letters)
    • Ability to use tact and diplomacy when appropriate
    • Ability to use superior discernment in stakeholder and provider communications
    • Ability to communicate effectively, professionally and comfortably with staff at multiple levels and from multiple functional areas and from various professional fields within provider/agency/group organizations (e.g., CEOs, CFOs, COOs, Contract Directors, Clinical Directors, Medical Directors, Program Directors, and various types of direct service professionals)
    • Ability to engage in light travel within the markets this position is responsible as needed
    • This is a salaried position and will require more than 40 hours per week at times to keep up with work or complete work assignments Are you ready for a challenge? You ll be part of a performance driven, fast paced organization that is serving multiple markets and you ll be charged with educating and building relationships with providers to evolve ongoing processes and programs.

      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 or equivalent work experience
      • 4+ years of health care/managed care experience
      • 3+ years of experience:
        • Working at a health plan / managed care organization contracting with behavioral health providers, especially Medicaid outpatient behavioral health
        • Negotiating behavioral health contracts between behavioral providers and health plans / managed care providers
        • Medicaid provider contracting experience
        • Working with behavioral health CPT codes
        • Interacting with behavioral health professionals and/or behavioral health organizational leaders when working with prospective providers
        • 2+ years of behavioral health provider contracting experience (actually preparing, negotiating and issuing contracts to providers)
        • 1+ years of experience with Washington State Medicaid programs and regulations, and Medicare programs and regulations
        • 1+ years of experience:
          • Proficiency using Excel to develop and analyzing behavioral health fee schedules using Excel
          • Proficiency with MS Word, Excel, PowerPoint and Access
          • Live in Washington State; light travel to various within the market will be required on occasion
          • Anticipate light travel to various cities throughout the state in 2022/2023. MUST have COVID card documenting has current COVID vaccinations prior to hire.
          • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements..... click apply for full job details

Keywords: UnitedHealth Group, Seattle , Optum Outpatient Behavioral Health Contracting - Telecommute in Washington State, Healthcare , Seattle, Washington

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