Managed Care Contracting Specialist

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 - advancing our mission to transform healthcare and serve as a leader of positive change.

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

A day in the life of a Managed Care Contracting Specialist at Hackensack Meridian Health includes:

• Ensures contracted rates are disseminated to appropriate internal users and updates internal systems.
• Works with Revenue Cycle Operations (RCO) and Digital Technical Services (DTS) system analysts to ensure correct implementation of Managed Care contracts for appropriate reimbursement.
• Educates RCO leadership regarding contractual interpretation inquiries and structural changes.
• Analyzes payer reimbursement to ensure proper claim adjudication, works with Managed Care payer account managers regarding identified contractual payment errors to recover revenue in a timely manner.
• Monitors, documents and reports internal and external trends that contribute to delays in correct payer reimbursement or denial reasons.
• Audits closed balance accounts to ensure accuracy of payments and identify potential recovery opportunities.
• Prepares monthly reports that include, but are not limited to, denials, claim dispute referrals and Managed Care payer recoveries.
• Analyzes claims data to identify internal pricing issues and collaborates with RCO, Contract Operations and DTS for pricing optimization.
• Identifies contractual areas of concern impacting revenue by monitoring financial performance and compliance with Managed Care contract terms to ensure revenue maximization and contractual optimization during the renewal process.
• Works closely with Managed Care leadership to develop processes and workflows on trends to increase revenue.
• Obtains updated rate schedules and fee schedules from Managed Care payer account managers to update systems in a timely manner.
• Performs additional ad‑hoc projects as assigned.
• Adheres to HMH organizational competencies and standards of behavior.

• Bachelor's degree or equivalent experience; a high school diploma, general equivalency diploma (GED), and/or GED equivalent programs.
• Minimum of two or more years of relevant experience.
• Knowledge of Managed Care contracts, Medicare and Medicaid.
• 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.
• Experience with Epic billing systems.
• Hospital and/or professional billing experience.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

HMH is committed to pay equity and transparency for our team members. The posted rate of pay is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market‑competitive total rewards package.

The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the…