Managed Care Contracting Specialist

Overview

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - transforming healthcare and serving as a leader of positive change.

The Managed Care Contracting Specialist will ensure that proper systems are in place to keep internal systems updated. They coordinate loading of rates and fee schedules for the enterprise, review internal calculated reimbursement and incoming payments to ensure alignment with contractual and payer policies, and work on directed projects tracking managed care contractual payer performance.

• Ensure contracted rates are disseminated to appropriate internal users and update internal systems.
• Collaborate with Revenue Cycle Operations (RCO) and Digital Technical Services (DTS) systems analysts to ensure correct implementation of Managed Care contracts for appropriate reimbursement.
• Educate RCO leadership regarding contractual interpretation inquiries and contractual structural changes.
• Analyze payer reimbursement to ensure proper claim adjudication; work with MC payer account managers on identified contractual payment errors to recover revenue in a timely manner.
• Monitor, document and report internal and external trends that contribute to delays in correct payer reimbursement or denial reasons.
• Audit closed balance accounts to ensure payment accuracy and identify potential revenue recovery opportunities.
• Prepare monthly reports (e.g., denials, claim dispute referrals, managed care payer recoveries).
• Analyze claims data to identify internal pricing issues and collaborate with RCO, Contract Operations and DTS for pricing optimization.
• Identify contractual areas of concern impacting revenue by monitoring financial performance and compliance with MC contract terms to maximize revenue during renewal.
• Work with MC leadership to develop processes and workflows on trends to increase revenue.
• Coordinate with MC Payer account managers to obtain updated rate and fee schedules for timely system updates.
• Perform additional ad hoc projects as assigned; other duties as needed.
• Adhere to HMH organizational competencies and standards of behavior.

• Bachelor's degree or equivalent experience with a high school diploma, GED, or GED-equivalent programs.
• Minimum of 2+ years of relevant experience.
• Knowledge of Managed Care contracts, Medicare and Medicaid.
• Thorough knowledge of billing requirements and regulations of major payers.
• Excellent written and verbal communication skills.
• Proficient computer skills including Google Suite and/or Microsoft Office.

• Strong analytical skills.
• Reporting experience.
• Epic billing systems.
• Hospital and/or professional billing experience.

If you feel that the description speaks to your strengths, please apply today!

Minimum rate of $72,072.00 annually. HMH is committed to pay equity and transparency. The posted rate is a reasonable good faith estimate of the minimum base pay for this role at the time of posting and does not reflect the full value of our market-competitive total rewards package.

Hackensack Meridian Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, race, color, creed, religion, sex, sexual orientation, gender identity or expression, pregnancy, genetic information, disability, marital status, or status as a protected veteran.