Contract Specialist | Managed Care Day Shift

Overview

To serve as primary point of contact with assigned managed care companies on all negotiating and operational issues. Responsible for monitoring contracts’ financial performance as well as payor compliance with all terms and conditions. Upholds positive relations with payors and internal customers, including revenue cycle, legal, clinic/hospital operations, and providers. Facilitates problem resolution, communication flow, and education while also maintaining appropriate documentation of issues and activities.

• Education:

  • Bachelor’s degree in business or a healthcare‑related field required.

  • Advanced managed care experience may substitute for the degree on a year‑by‑year basis.

  • A Master’s degree may substitute for the required experience on a year‑by‑year basis.

• Experience:

  • Minimum of two (2) years of managed care industry experience in at least two (2) of the following areas:

    • Contract language review
    • Financial negotiation of hospital and physician contracts
    • Provider relations
    • Revenue cycle
    • Financial or reimbursement analysis
    • NCQA/HEDIS requirements
    • AHCA/CMS regulations
    • Utilization review/management
    • Member services
    • Account or service management (marketing)
  • Preferred: Three (3) to five (5) years of managed care experience.

• None

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