Sr. Network Pricing Consultant - Remote

Requisition Number: 2349153
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.
Primary 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

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:

• 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

Preferred Qualifications:

• 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

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.