Managed Care Specialist
On-siteLouisville, Kentucky, United States or Richardson, Texas, United States
Job Summary
Interpret managed care contract terms, payment methodologies, and reimbursement hierarchies to identify risks and opportunities for healthcare provider clients. Interview provider personnel to gather information on payer relationships, contract performance, and historical reimbursement trends. Work with clients to define issues, develop practical work plans, and support implementation of recommended solutions. Support managed care contract negotiations by identifying and prioritizing client needs and goals to help achieve favorable outcomes. Build and maintain productive relationships with payers and providers that promote collaboration and trust. Review, test, and analyze utilization and reimbursement data sets from healthcare providers. Develop and maintain financial and reimbursement models using database and spreadsheet tools. Prepare exhibits, analyses, and narrative reports that clearly communicate findings and reimbursement impacts. Communicate regularly, verbally and in writing, with healthcare providers, health plans, and internal project teams. Review insurance contracts, applicable state requirements, and financial documentation to support client recommendations. Requires two to six years of managed care experience, including review and negotiation of payer contracts. Advanced proficiency in Microsoft Excel and Word; experience with database or analytics tools is preferred.
Required Qualifications
- Two to six years of managed care experience, including review and negotiation of payer contracts
- Working knowledge of managed care contract language, payment methodologies, and contract modeling
- Basic understanding of value-based contracting principles
- Strong analytical skills, attention to detail, and ability to prioritize work to ensure accurate and timely completion
- Strong investigative, written, and verbal communication skills, with the ability to communicate effectively with internal and external stakeholders
- Excellent organizational and documentation skills
- Advanced proficiency in Microsoft Excel and Word
- Ability to work independently and thrive in a fast-paced environment with changing priorities
- Strong interpersonal skills, including the ability to listen, influence, and build credibility with senior leaders, clients, providers, and payers
- Ability to organize and lead professional business meetings and deliver oral presentations
- Candidates must be authorized to work in the United States without current or future employer sponsorship
- Agency candidates will not be considered for this position
Desired Qualifications
- Strong experience with contract modeling highly preferred
- experience with database or analytics tools is preferred
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