Managed Care Contract Specialist (REMOTE)

Job Description:

Managed Care Contract Specialist (REMOTE)

This position works in collaboration with the Vice President of Contracting and Senior Director of Payor Relations to assist with all aspects of managed care operations including contract negotiation, contract payment modeling, and contract implementation. This position acts as a liaison between Payor Relations and other internal and external entities to create seamless operational managed care performance along with maximizing payor contracting terms. The individual will be responsible for high-level, sophisticated reporting, modeling, and analyses using both hospital and professional claims data. This employee adeptly collaborates with management, operations, and administrative support teams to efficiently undertake the necessary steps crucial for successful contract negotiations. This position will make sure that negotiations are handled efficiently to meet important deadlines and remain within approved financial parameters.

Responsibilities

1. Financial Success
   1. Lead and oversee all stages of the payor contract management cycle, ensuring timely execution and adherence to organizational parameters, contributing to financial success.
   2. Initiate and facilitate contract negotiations, focusing on securing favorable payment rates and terms to enhance organizational performance and financial outcomes.
   3. Provide thorough document management for contracts, including tracking changes and seeking input from relevant parties, ensuring accuracy and compliance with contractual obligations.
   4. Negotiate individual patient agreements to ensure optimal reimbursement and financial success for the organization.
   5. Performs high-level decision support analyses, financial modeling, and report preparation to assist with payor negotiations, resolution of claim issues, or other ad hoc requests
2. Operational Excellence
   1. Proactively review healthcare trends to identify opportunities for operational improvement and optimization of contracts, contributing to operational excellence.
   2. Communicate complex issues effectively and represent the organization positively in various contexts, ensuring clear understanding and alignment with operational goals.
   3. Exhibit thorough attention to detail and accuracy while delivering timely work products, maintaining operational excellence in contract management.
   4. Identify and collaborate on opportunities for continuous improvement in contract management processes, including contract terms, to enhance efficiency, effectiveness, and alignment with organizational goals.
   5. Performs other job-related duties as assigned to fulfill departmental and organizational responsibilities.

Qualifications

Experience - 3-4 years of experience needed

Education - Bachelor's Degree in Business, Finance, Healthcare Administration or related field

Knowledge/Skills/Abilities - Attention to detail, Financial Acumen, Effective communication, Healthcare reimbursement, and Managed care contract negotiation