The Managed Care Specialist partners with the Manager of Contracting and Payor Relations on the implementation of payor strategy, focusing on payor operations, client services, and process improvement. This role ensures resolution of payor issues received from the field, leadership, or other internal departments, tracking of opportunities, and continual documentation and improvement of processes.

Responsibilities

• Assist with implementation of payor strategy in partnership with the Manager of Contracting and Payor Relations.
• Maintains a thorough operational knowledge of contractual agreements and specific contractual language with Payors.
• Collaborate with credentialing regarding demographic updates and needs related to contracting efforts.
• Collaborates with Operations, legal, billing, and compliance to track and resolve payor issues, including payment and/or billing disputes.
• Continually create, document, and improve processes to provide clear communication throughout the lifecycle of contracting efforts.
• Determine and implement any tools or technology required to assist in providing communication and updates to leadership and other relevant stakeholders.
• Manages contract assignments and any documentation relevant to the negotiation, strategy, and/or implementation of the contract.
• Proactively monitor and report current contracting efforts.
• Partner with internal team to ensure that contracting efforts align with company and divisional goals.
• Communicate with relevant stakeholders to ensure contract commitments are operationalized.
• Performs various tasks assigned related to contracting.
• Additional duties as assigned

Requirements

• Bachelor’s degree, required
• 3-5 years healthcare experience, preferably with a payor or provider, required
• Prior health care provider or health plan contracting, contract operations, service operations, or provider relations experience, preferred .