Summary

The ideal Managed Care Specialist will leverage a background in provider, payer, and facility contracts to support the department in developing, negotiating, implementing, monitoring, and managing managed care agreements. You will research managed care trends and be responsible for accurate and timely communication of changes that may impact the performance of a contract. As the Managed Care Specialist, you’ll assist in reviewing and analyzing routine reports to determine that contracts are performing according to expected results and distribute accurate information to all departments within the Company. While building and nurturing positive relationships with clients, providers, payers, and internal team members, you will also prepare presentations and, in some cases, participate in or lead those presentations. Even though travel is required for this position, this will be rare.

What We Offer:

• Competitive pay and performance incentives
• Medical, vision, and dental insurance
• Employer-paid life insurance
• Paid time off
• Paid holidays
• Flexible schedules
• Opportunity to build a meaningful career

Roles & Responsibilities

• Serve as an internal and external liaison to resolve managed care issues; assist with client, provider, payer, and facility communications; and perform claims research to maintain positive relationships with providers and payers.

• Field, manage, and resolve client, provider, and payer support inquiries.

• Assist in developing our initiatives by providing analysis and research of managed care trends and benchmarks.

• Assist in reviewing and preparing payer and provider agreements and participate in developing negotiation strategies.

• Collaborate with other departments requiring contract, payer, and provider information to ensure efficient workflow processes.

• Assist with client onboarding related to our payer and provider contracts.

• Monitor and contact provider offices for the status of documents; Distribute executed documents to provider offices.

• Attend and provide coordination and administrative functions for our various committees.

• Track and alert Management of the status of agreements (expiration, changes, notices).

• Analyze and track the performance of provider and payer contracts.

• Enter, maintain, and validate provider contracting and demographic information in software systems and databases.

• Monitor, review, and track payer notices of changes in policies and procedures.

• Assist Management and Quality Staff with Clinical Integration provider inquiries, education, and reports

Required Experience / Qualifications

• BS/BA in business, finance, or related field required

• 5 years’ experience with a healthcare provider, facility, or payer in contracting or business operations, including reporting, managed care contracting, and patient account resolution; cardiology office setting experience a plus

• Knowledge of various value-based care reimbursement models

• Working knowledge of CPT and ICD-10 codes and medical terminology

• Strong computer skills in Microsoft Office (Office 365, Outlook, Excel, Word and PowerPoint)

• Strong negotiation and decision-making skills.

• Exceptional critical thinking and analytical skills

• Ability to work well under pressure by prioritizing and managing multiple tasks to meet performance expectations and deadlines.

• Exceptional customer service skills with superior written and verbal communication skills

• Knowledge of technology, network infrastructure, and interface requirements associated with software integrations a plus

• Maintain a professional, businesslike image to clients, visitors, internal staff and the public

• Possess a positive attitude and a willingness to learn

• Self-motivated and team-oriented

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Experience:

• Managed Care Specialist: 1 year (Preferred)

Location:

• Dallas, TX (Required)

Work Location: Remote