Behavioral Health Contracting - California and Western United States - Remote

Behavioral Health Contracting Specialist

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. 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.

For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Person will 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.
• Activities include 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
• Will 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
• Presents and reports verbally and in writing to state regulators via conference calls about Medicaid contracting, provider contracting, network adequacy, recruitment development and related topics
• Works with behavioral health CPT, DRG, per diem and RBRVS and per member per month reimbursement methodologies
• Uses higher-level discernment and decision-making abilities that enable someone to support and work with upper level-management and state regulators
• When interacting with providers, manages health plan's clear expectations to providers about timelines for contracting, credentialing, reimbursement levels and methodology, site audits, and the like
• Develops and maintains 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
• Issues provider applications, agreements and related documents to providers
• Gathers 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
• Assembles provider agreements consisting of base agreements, appendices and addendums, fee schedules and related documents
• Coordinates and follows-up with provider relations advocates to ensure timeliness of submission of applications and related documents
• Is continually engaged; promptly responds 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.
• Understands 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)
• Models: personal responsibility, dependability, reliability and flexibility in being able to meet the needs of the team and business; accepts responsibility and accountability for actions; continually learns and retains/absorbs knowledge, information and skills to perform the position as you work independently
• Models integrity and honesty; behaves 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
• Models 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
• Reports 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 participates 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 participates 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.
• Communicates throughout each workday via emails and phone communication with internal and external customers, including supervisor and team members
• Works 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; this is a salaried position and will require more than 40 hours per week at times to keep up with work or complete work assignments

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:

• 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

Preferred Qualifications:

• 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