Provider Contract Specialist - Remote

UnitedHealth Group•La Crosse, WI

1d•$60,200 - $107,400•Remote

About The Position

Logistics Health Incorporated (LHI), part of the Optum family, is seeking a Provider Contract Specialist to serve as the primary liaison between Optum Serve and network providers. This remote role focuses on strengthening provider relationships, ensuring retention, and resolving operational issues and concerns. The Specialist will also research and resolve accounts payable questions, negotiate cost-effective fees, verify provider capabilities, and educate providers on contract requirements and processes. A strong understanding of customer contractual obligations is essential to translate subcontractor agreements and fee structures for providers. The ideal candidate can assess situations from multiple viewpoints to determine beneficial solutions for both Optum Serve and its provider network.

Requirements

High School Diploma/GED (or higher)
2+ years of experience in provider relations
Intermediate proficiency with Microsoft Office (Word, Excel, and Outlook) and the ability to navigate multiple web-based applications
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Candidates are required to pass a drug test before beginning employment.

Nice To Haves

Experience with medical billing/claims
Knowledge of medical terminology
Knowledge or experience negotiating rates and managing subcontractor relationships
Knowledge of MedNet
Proven ability to manage provider accounts and support provider retention
Demonstrated ability to build strong professional relationships within complex business structures

Responsibilities

Assess, address and resolve provider concerns by developing and implementing solutions that support both provider satisfaction and customer needs
Negotiate cost-effective fees, ensuring alignment with provider capabilities and educating providers on complex contract expectations, fee structures, and operational processes
Interpret provider issues and translate them into actionable guidance for internal operational teams to improve provider support
Proactively monitor provider compliance, readiness and performance to maintain active network status
Collaborate closely with scheduling, contracting, claims, credentialing, and operational teams to ensure contractual performance requirements are met
Manage and resolve complex provider complaints and escalations within tight deadlines while ensuring accuracy and adherence to contractual standards
Assist in complex end-to-end provider claims processing and resolution, including but not limited to, claims reprocessing, modifying orders, and adhering to contractual guidelines within claim requirements
Assist in identifying gaps in network composition, services, or provider availability and support network contracting and adequacy teams in addressing these needs
Support network contracting efforts to ensure effective network adequacy and accessibility metrics across contracts
Analyze data trends, performance metrics, and operational insights to identify issues, recommend improvements, and collaborate with support teams to resolve non-standard or complex problems
Serve as a subject-matter resource for less experienced team members and contribute to a positive and collaborative work environment
Facilitate provider focused discussions, including JOC meetings, on performance trends, expectations, and operational improvement opportunities
Represent provider perspectives in multi-department forums to help shape process improvements and network strategies
Manage and prioritize workload effectively to meet deadlines and ensure timely communication with leadership, providers, and partners
Travel as needed during business hours (up to 10%25 within 100 miles of assigned territory)
Perform other duties as assigned