Managed Care Contract Specialist

Company Description

Aegis Health Services is dedicated to driving better patient outcomes through population health management. The organization focuses on improving healthcare delivery by ensuring that patients receive coordinated and comprehensive care. With a strong emphasis on quality, Aegis Health Services strives to create impactful and sustainable solutions in the healthcare industry.

Role Description

The Managed Care Contract Specialist will play a key role in obtaining, enrolling, and optimizing payer contracts for Aegis Health Services. This role will directly support revenue cycle in analyzing reimbursement, preparing negotiation strategies, and executing payer contracts.

Duties will include but are not limited to:

• Processing Medicare, Medicaid, and commercial payer enrollments and credentialing for the group and individual providers.
• Processing revalidations with Medicare, Medicaid, and commercial payers.
• Researching, soliciting, and negotiating contracts with commercial payers.
• Preparing payer negotiation materials, including rate comparisons, market benchmarks, and review of price transparency
• Monitor contract renewal timelines and proactively identify renegotiation or termination opportunities
• Managing payer relationships including communications, issue resolution, and data requests.
• Collaborating with the revenue cycle team on underpayments and denials due to provider enrollment and credentialing related issues.
• Maintaining accurate and up-to-date records in compliance with organizational standards and regulatory requirements.
• Preparing reports on credentialing activities for management review.

Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Finance, or related field
• 5 years of experience in manage care and payer contracting
• Experience working with national and regional payers such as United Healthcare, Aetna, Cigna, Blue Cross Blue Shield, Humana, and United Healthcare preferred
• Experience in contract negotiations or payer strategy development preferred
• Ability to interpret and analyze fee schedules, contracts, and reimbursement terms
• Highly organized with strong attention to detail and ability to manage multiple projects simultaneously
• Knowledge of claims adjudication, denial management, and payer policies preferred
• Strong communication skills with the ability to interface with internal leadership and external stakeholders

**Salary compensation is based on experience**

$65,000-$75,000