Sr. Network Pricing Consultant - Remote

UnitedHealth Group•Orlando, FL

1d•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Undergraduate degree or equivalent work experience
5+ years of analytical experience in financial analysis, healthcare pricing, network pricing, healthcare economics or related discipline
Experience optimizing analytical models for performance
Demonstrated ability to efficiently work with large datasets (e.g., high row-count extracts) optimizing calculations and reducing workbook performance constraints
Advanced level of proficiency in MS Excel
Experience in MS Access, SAS and/or SQL
Intermediate ability to interpret and review financial modeling results to evaluate the financial impact of contract changes and develop forecasts
Prior presentation experience to internal or external stakeholders or customers
Demonstrated ability to manage multiple projects simultaneously and meet deliverable deadlines

Nice To Haves

3+ years of experience with provider payment methodologies and healthcare products
Experience with medical coding (CPT, MSDRG, REV, ICD-10, etc.)
Experience leveraging enterprise-approved AI tools to streamline workflows, automate repetitive tasks, and drive continuous improvement in analytical processes and reporting
Knowledge of Commercial, Medicare, and Medicaid PPO and HMO revenue and expense, as well as delegation financial modeling
Power Pivot/Data Model and DAX
Excellent financial impact analysis, risk management, and data manipulation skills
Excellent interpersonal, collaboration, negotiation and communication skills
Ability to research and solve problems independently

Responsibilities

Lead Out-of-Network Analyses:
Utilize and enhance tools developed within the team (Predictive Models, Non-par Status Reports) to model/report impacts of potential/actual contract terminations
Identify, investigate, and resolve discrepancies in spend, law application, and Out-of-Network program applicability
Maintain timely processing and tracking of Out-of-Network model requests and communicate with local markets
Peer-review Tier 1 models for accuracy
Support training initiatives and identify training gaps
Support Out-of-Network dispute resolution strategy initiatives associated with Federal No Surprises Act (NSA) and state Surprise Medical Bill (SMB) applicable claims
Manage data and lookup resources, integrating updates into models
Update models with changes to laws or annual Qualified Payment Amount (QPA) updates
Produce Ad Hoc Out-of-Network Analyses:
Independently produce ad-hoc reports using SQL queries and existing models
Demonstrate Advanced Out-of-Network Knowledge:
Understand state/federal surprise medical bills (SMB) and other Out-of-Network (OON) programs
Customize reports using SQL and understand impact on model formulas
Assist local pricing during terminations and develop talking points
Solve errors and enhance Excel formulas/macros in models
Demonstrate Advanced Consulting Mindset:
Lead complex termination calls, manage Shared Savings Program (SSP) Wrap decisions, and track negotiations
Prepare for calls with research and tools to provide recommendations
Present confidently and act as a subject matter expert for Out-of-Network (OON)-related questions