Provider Network Contracting Specialist (LHI) – UnitedHealth Group – La Crosse, WI

At Optum, the mission is clear: Help people live heathier lives and help make the health system work better for everyone

LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well-being of Americans.

By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.

LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on-location services, patient-specific in-clinic appointments, telehealth assessments, or any combination based on customer need. LHI’s customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

There’s an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life’s best work.

The Provider Network Contracting Specialist (LHI) – La Crosse, WI, Eau Clair, WI and Tampa, FL will build and maintain a successful working relationship between LHI and network providers to ensure a geographically competitive, broad access and stable network. Routinely negotiate cost effective fees, confirm service capability, respond to provider inquiries, and educate providers on contract expectations, processes and paperwork. Support implementation of strategies relating to the development and management of the provider network. Comprehend detailed knowledge of contracts in order to translate subcontractor and fee agreements to the providers. Must be able to routinely evaluate and negotiate contracts in compliance with company contract templates, reimbursement standards, and other key process controls, while maintaining network composition that includes an appropriate distribution of provider specialties.

Primary Responsibilities:

  • Recruit and contract providers according to LHI and department policy

  • Must understand contracts between LHI and LHI customers and how this translates to the subcontractor agreement and fee arrangements between LHI and all providers

  • Negotiate contracts and fees that align provider needs and LHI business objectives

  • Educate providers on fee structures to ensure collaborative agreement and understanding of LHI Services and the fees associated with them

  • Initiate appropriate credentialing processes and workflows

  • Assess and resolve specific provider concerns, developing and implementing solutions that are beneficial to providers, LHI Customers and LHI

  • Provide explanations and information to others on topics within area of expertise

  • Manually assign qualified providers to orders within the contractually allowed mileage radius

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