What are the responsibilities and job description for the Managed Care Specialist position at Blue and Company?
Blue & Co., LLC is a dynamic, innovative professional services firm that provides accounting and consulting services to growth-oriented, entrepreneurial clients across multiple industries. Healthcare is our largest industry focus, supported by more than 150 experienced professionals dedicated to serving the sector.
We are seeking a Managed Care Specialist to provide subject matter expertise and technical support related to managed care contracts, reimbursement modeling, and operational best practices. The Specialist will work with Blue’s growing Healthcare Reimbursement and Revenue Cycle teams to help healthcare provider clients address managed care and reimbursement challenges.
Position Responsibilities
- Interpret managed care contract terms, payment methodologies, and reimbursement hierarchies to identify risks and opportunities for healthcare provider clients.
- Interview provider personnel to gather information on payer relationships, contract performance, and historical reimbursement trends.
- Work with clients to define issues, develop practical work plans, and support implementation of recommended solutions.
- Support managed care contract negotiations by identifying and prioritizing client needs and goals to help achieve favorable outcomes.
- Build and maintain productive relationships with payers and providers that promote collaboration and trust.
- Review, test, and analyze utilization and reimbursement data sets from healthcare providers.
- Develop and maintain financial and reimbursement models using database and spreadsheet tools.
- Prepare exhibits, analyses, and narrative reports that clearly communicate findings and reimbursement impacts.
- Communicate regularly, verbally and in writing, with healthcare providers, health plans, and internal project teams.
- Review insurance contracts, applicable state requirements, and financial documentation to support client recommendations.
Position Requirements
- Two to six years of managed care experience, including review and negotiation of payer contracts.
- Working knowledge of managed care contract language, payment methodologies, and contract modeling.
- Strong experience with contract modeling highly preferred.
- Basic understanding of value-based contracting principles.
- Strong analytical skills, attention to detail, and ability to prioritize work to ensure accurate and timely completion.
- Strong investigative, written, and verbal communication skills, with the ability to communicate effectively with internal and external stakeholders.
- Excellent organizational and documentation skills.
- Advanced proficiency in Microsoft Excel and Word; experience with database or analytics tools is preferred.
- Ability to work independently and thrive in a fast-paced environment with changing priorities.
- Strong interpersonal skills, including the ability to listen, influence, and build credibility with senior leaders, clients, providers, and payers.
- Ability to organize and lead professional business meetings and deliver oral presentations.
We are responsive. We are caring. We are advocates.
Blue & Co., LLC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, sex, sexual orientation, gender identity, disability, genetic information, national origin, race, religion, veteran status, or any other protected category.
Candidates must be authorized to work in the United States without current or future employer sponsorship.
Agency candidates will not be considered for this position.
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