As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

• This position for use in Health Plans Departments only.
• This position negotiates provider contracts, conducts reimbursement analysis, evaluates potential network providers, develops and maintains contracted physician fee schedules and provides assistance on ad hoc contracting projects.
• This position is not responsible for providing care to patients.

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

• Plays a key role in establishing and maintaining strong effective relationships with providers serving as the liaison between UUHP and the provider organization, medical group and other healthcare providers.
• Negotiates low-volume, single-department, letter of agreements and invoice settlements with providers.
• Ensures all contracts are properly drafted and executed.
• Coordinates with multiple departments to ensure contract terms and provisions are effectively communicated and implemented.
• Serves as a resource to assist with escalated billing and policy issues.
• Conducts reimbursement analysis to determine financial impact.
• Conducts an analysis of potential network providers to assess potential business compatibility.
• Audits and trouble shoots negotiated reimbursement terms with claims and contract compliance systems.
• Maintains current knowledge of appropriate contractual provisions and of government regulations related to the establishment and maintenance of contractual arrangements.
• Represents provider relations and contracting department at meetings.

Knowledge / Skills / Abilities

• Ability to perform the essential functions of the job as outlined above.

• Strong oral and written communication skills to effectively communicate with a broad array of internal and external contacts.

• Proven ability to build and maintain positive relationships.

• Knowledge and understanding of the provider community and principles of healthcare delivery systems.

• Self-motivated with effective time management skills.

• Working knowledge of healthcare operations and billing principles.

• Good analytical and problem solving abilities.

• Experience using word processing, spreadsheet, database, internet and e-mail applications.

Qualifications

Required

• Bachelor's degree in Business, Health Care Administration, Accounting, Nursing, or equivalency.
• Three years of health care industry or health insurance industry experience.

Preferred

• Knowledge of ICD9 and CPT codes.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.