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Network Pricing Consultant

Company: Optum
Location: Albuquerque
Posted on: October 19, 2020

Job Description:

Full Time Opportunity for Network Pricing Consultant, Roma LocationOverview of Position: Network Pricing Consultant supports and validates Provider Network (physicians, hospitals, pharmacies, ancillary facilities, etc.) contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting. Conducts unit cost and contract valuation analysis in support of network contracting negotiations and unit cost management strategies. Manages unit cost budgets, target setting, performance reporting, and associated financial models. Adheres to policies, procedures and regulations to ensure compliance and patient safety.--Participation in Compliance and other important training is a condition of employment.Essential Functions:

  • Analyze financial impact of provider contracts (e.g., facility physician, ancillary)
  • Analyze financial impact of corporate initiatives (e.g., policy changes; healthcare affordability) or external regulations (e.g., healthcare reform)
  • Develop/maintain/update databases and tools needed to perform and support contract modeling
  • Analyze payment appendices to provide options for various contracting approaches and methodologies
  • Identify and investigate discrepancies (e.g., difference between actual allowed amount and modeled payment amount) in claim reimbursements
  • Review charge master to ensure trending assumptions are correct
  • Perform quality check to ensure contract provisions and rates in the model match payment appendices
  • Review competitive analysis to identify appropriate pricing rate for provider
  • Communicate results of financial impact and analysis to appropriate stakeholder groups (e.g., Network Management; Network Pricing leadership)
  • Other duties as assigned.Education:-- Required - Bachelor's Degree in related field. Related Education and Experience may be substituted for one another on a year for year basis.Experience: Required:-- Three (3) years of previous job related experienceKnowledge, Skills, AbilitiesDemonstrate knowledge of relevant computer software (e.g.,SAS, Excel; Oracle: SQL)Knowledge of commercial, Medicare, and Medicaid reimbursement policiesKnowledge of different contracting methodologies (e.g., capitation, PPR, Per Diem, DRG; fee schedule)Knowledge of internal Network Pricing and Corporate policies and proceduresKnowledge of various claims payment methodologies (e.g., multiple procedure logic, packaging logic, RBRVS; CPT, DRG, Modifiers)Knowledge of network strategies (e.g. PCMH; ACO, PBC)Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you'll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Optum, Albuquerque , Network Pricing Consultant, Professions , Albuquerque, New Mexico

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