Behavioral Health Contracting - California and Western United States - Remote

UnitedHealth Group•Cypress, CA

4h•Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. This role contributes to improving health outcomes by connecting people with care, pharmacy benefits, data, and resources. The position offers flexibility to work remotely from anywhere within the U.S., though hires in the Minneapolis or Washington, D.C. area are required to work in the office a minimum of four days per week. The individual will be responsible for recruitment and contracting functions to build and maintain a high-quality, competitive behavioral health network in California and other Western US States, ensuring compliance with access, availability, and regulatory standards. This includes managing system updates, fee schedule negotiations, and serving as a contracting subject matter expert.

Requirements

3+ years of health care/managed care experience that includes the following:
Significant hands-on experience with medical / facility and/or behavioral health provider contracting in the California market.
Working at a health plan / managed care organization contracting with medical and/or behavioral health outpatient and facility providers.
Negotiating behavioral health contracts between behavioral providers and health plans / managed care providers for commercial, Medicare and/or Medicaid lines of business.
Working with both outpatient and facility reimbursement codes and methodologies.
Interacting with behavioral health professionals and/or behavioral health organizational leaders when working with prospective providers.
Solid working knowledge of California geography, counties, cities and providers (hospitals, clinics and other providers by location) as well as geography and behavioral health provider markets of in Western US.
Proficiency using Excel to develop and analyzing behavioral health fee schedules using Excel.
Proficiency with MS Word, Excel, PowerPoint and Access.
Understanding and experience with health plan reimbursement, finance and underwriting principles.
Ability to: use tact and diplomacy; use superior discernment in stakeholder and provider communications; communicate effectively, professionally and comfortably with staff at multiple levels and from multiple functional areas and from various professional fields within provider/agency/group/facility organizations.
Experience contracting with providers for commercial, Medicare and Medicaid lines of business.

Nice To Haves

2+ years of experience with two or more of the following:
Experience working with health plan finance and/or underwriting staff developing provider payment strategies, reimbursement amounts, fee schedules and payment tables.
Experience working with health plan legal counsel reviewing contract language modifications.
Commercial, Medicare and/or Medicaid behavioral health provider contracting experience.
High level of proficiency working with Excel spreadsheets, analyzing fee schedules, developing and maintaining fee schedules, and analyzing provider reimbursement increase requests.
Behavioral health contracting experience in Idaho, Nevada and Utah a plus.
Basic understanding of role of California health plan regulatory framework in California and other states.
Knowledge of Medicare and CMS regulations and state Medicaid regulations.
Exceptional verbal and written communications.
Use appropriate demeanor, wear business appropriate dress, body language during interpersonal communications via video conference calls and in-person meetings.
Use appropriate business language in written communications (emails, memos and letters) that are tailored to the to the situation and immediate audience / personalities.
Foresee potential distribution and use of written (especially email) communications to audiences if later shared elsewhere by the recipient (e.g., executives, providers, regulators and media).
Ability to use tact and diplomacy when applicable, and use superior discernment in both internal and external stakeholder in both verbal and written communications on topics when communicating on a sensitive topic.
Ability to confidently interact and communicate with individuals-internally and externally-in a variety of organizations levels and roles.
Ability to always be courteous and professional (“taking the higher road”) when interacting internal or external stakeholders regardless of how they behave or act.
Ability to work with providers/agencies/groups and tell them “no” to various contract and reimbursement requests with respect and tact and confidence.
Always treat external and internal stakeholders with dignity and respect.
Solid internal and external customer service skills.
Demonstrated track record of successful behavioral health contracting negotiation skills.
Solid internal resource negotiation skills.
Exceptionally well-organized self-starter who is able to learn quickly and often on own, work with minimal supervision and keep up with workload.
Ability to: work in a very fast-paced work environment with multiple, competing priorities; follow-through with assignments and tasks is a MUST with both internal and external customers; keep up with heavy workload; learn the position and begin performing the work quickly; navigate complex, challenging external and internal stakeholder relationships without it interfering with ability to accomplish job duties and work directives in effective and efficient manner; negotiate contract language modifications with providers and work with legal counsel; manage multiple projects and assignments while juggling various internal and external conference calls and respond to providers, internal customers via email and phone on a timely basis and update fee schedules, and process rate increase requests, and issue contacts and amendments on timely basis.

Responsibilities

Work Pacific Standard Time (PST) to work primarily with behavioral health provider community during their business hours 8 am to 5 pm PST in California and other Western US States which may include but not be limited to Idaho, Nevada, and Utah.
Recruitment and contracting functions for the building and ongoing maintenance of a high quality, competitive behavioral health network (outpatient and facility providers) that meets all access & availability and regulatory standard/requirements.
Accountable for all system updates associated with California and other state commercial, Medicare and Medicaid contract negotiations/network changes/addition of new providers and programs, including fee schedule negotiations and fee schedule development and maintenance.
Responsible for end recruitment and contracting, including end-to-end contracting processes for new programs and products and serving as a contracting subject matter expert for assigned states, lines of business and programs within those states.
Serve as contracting back-up to peers for other assigned states and will learn to learn those states too.
Attendance at the various internal and extern meetings with State customers/regulators, Provider and Health Plan stakeholders in assigned states.
Regular interface and leadership role with health plan leadership, account managers, internal behavioral health functional leadership including finance and underwriting, provider leadership, and state regulators.
Work with behavioral health economics, legal, finance and underwriting in development, maintenance and monitoring of provider payment arrangements.
Present and report verbally and in writing to state regulators via conference calls about Medicaid contracting, provider contracting, network adequacy, recruitment development and related topics.
Work with behavioral health CPT, DRG, per diem and RBRVS and per member per month reimbursement methodologies.
Use higher-level discernment and decision-making abilities that enable someone to support and work with upper level-management and state regulators.
Manage health plan’s clear expectations to providers about timelines for contracting, credentialing, reimbursement levels and methodology, site audits, and the like when interacting with providers.
Develop and maintain primary network contracting relationships with external (e.g., behavioral health providers, behavioral health groups, behavioral health agencies/community mental health agencies/federally qualified health clinics, facilities, provider associations, tribal government and other tribal organizations, government agencies) and internal customers; these relationships will be positive and productive.
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.
Assemble provider agreements consisting of base agreements, appendices and addendums, fee schedules and related documents.
Coordinate and follow-up with provider relations advocates to ensure timeliness of submission of applications and related documents.
Promptly respond to external and internal customer inquiries; responsible for remaining engaged with external and internal customers until tasks are complete; responsible for proactively keep external and internal customers updated about status of requests; communicates 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.
Understand our 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.
Model personal responsibility, dependability, reliability and flexibility in being able to meet the needs of the team and business; accept responsibility and accountability for actions; continually learn and retains/absorbs knowledge, information and skills to perform the position as you work independently.
Model integrity and honesty; behave 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 and conflict resolution.
Model 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.
Report to the Director of Outpatient Behavioral Health Contracting of the Western U.S.; Keep Director updated on timely basis about provider network development, contracting developments, rate negotiations, rate increase requests, emerging issues and the like; actively participates in Western U.S. Outpatient Behavioral Health Contracting Team Meetings and collaborates with peers.
Use proprietary and other software programs for sending, updating and storage of provider/agency/group/facility contracts and numerous fee schedules and related contractual documents.
Actively participate in scheduled and ad hoc joint Provider Relations - Outpatient Behavioral Health Contracting Meetings to ensure continuity of communication and coordination between; proactively copies provider relations colleagues on provider communications to keep them in the loop about provider communications.
Actively participate on a regular basis with a variety of internal meetings with various functional areas including but not limited to provider services/provider relations, network strategy, legal, other contracting teams, project managers, health care economics, finance, underwriting, clinical, clinical operations, compliance, claims, consumer affairs, information technology, and sales.
Communicate throughout each workday via emails and phone communication with internal and external customers, including supervisor and team members.
Work in a fast-paced work environment with multiple, every-changing competing priorities.
Required to work office hours of 8:00 am to 5:00 pm PST as a telecommuter in order to respond to internal and external customers.