What are the responsibilities and job description for the Managed Care Specialist position at Cedar Gate Technologies and Careers?
Position Summary
Why You’ll Love Working in This Position:
- Limitless Growth: Join a rapidly expanding company where top performers are recognized and promoted. At Cedar Gate, your career potential is only limited by your ambition.
- Meaningful Work: We prioritize both employee well-being and delivering exceptional results for clients, revolutionizing healthcare.
- Flexible Work Life: Enjoy our hybrid remote schedule, which offers flexibility to balance your work productivity and dynamic personal life.
- Robust Benefits: Enjoy comprehensive medical, dental, and vision coverage, FSA/HSA options, 4% 401(k) matching, tuition assistance, generous paid time off, exclusive employee discounts, and more.
- Rewarding Culture: Work alongside a high-performing, supportive team that celebrates success together.
Summary
Join Cedar Gate Technologies as a Managed Care Specialist! We’re looking for a dynamic new employee to help shape and manage our provider, payer, and facility contracts. In this role, you’ll develop, negotiate, implement, monitor, and optimize managed care agreements that support our growth and quality of care. You’ll stay on top of industry trends, communicate contract changes across the organization, and analyze performance data to ensure agreements deliver the expected results.
Join Cedar Gate Technologies as a Managed Care Specialist! We’re looking for a dynamic new employee to help shape and manage our provider, payer, and facility contracts. In this role, you’ll develop, negotiate, implement, monitor, and optimize managed care agreements that support our growth and quality of care. You’ll stay on top of industry trends, communicate contract changes across the organization, and analyze performance data to ensure agreements deliver the expected results.
As a Managed Care Specialist, you’ll also collaborate closely with internal teams, clients, payers, and providers, building strong relationships and preparing presentations – with the chance to lead or co-present on key initiatives.
Roles & Responsibilities
- Act as a key liaison between internal teams, providers, and payers — resolving managed care issues, assisting with provider communications, and researching claims to maintain strong relationships.
- Support clients, providers, and payers with a focus on timely and effective inquiry resolution.
- Build and nurture positive relationships with providers, payers, and internal stakeholders to support seamless operations.
- Research managed care trends and benchmarks to provide analysis and recommendations.
- Prepare data and insights to support negotiations with payers, employers, and providers; present findings to senior leadership.
- Coordinate and prepare all documentation for the Contract Committee and Board, ensuring accuracy and compliance.
- Assist with the review of payer and provider agreements and help develop negotiation strategies.
- Prepare and present quarterly payer account summaries to departmental leadership.
- Partner with other departments to ensure smooth workflows and accurate contract and provider information.
- Support client onboarding by managing payer and provider contract details.
- Track agreement statuses (expirations, changes, notices) and proactively alert management to required actions.
- Maintain and validate data across systems (including Cactus and other platforms) to ensure accuracy and completeness.
- Monitor payer updates in policies and procedures and distributing pertinent information to the appropriate teams in a timely manner.
- Create, organize, and maintain provider and payer contracting documents in both electronic and paper formats.
- Coordinate with provider offices to secure the timely completion of documents and distribute executed agreements properly.
- Contribute to Center of Excellence programs, including member education, helpline support, enrollment, and reporting.
- Maintain organized systems, filing structures, and resources to support department efficiency.
- Assist with special projects and additional tasks as assigned.
Job Location
Hybrid Remote: Enjoy the flexibility of working from home and collaborating three days a week at our office in Houston, Texas
Required Experience / Qualifications
- BS/BA in healthcare administration, business, finance, or related field; relevant work experience may be considered
- 3 or more years of experience in healthcare contracting or business operations, including reporting, managed care contracting, and patient account resolution with a provider or payer.
- Experience with claims payment resolution
- Strong Microsoft Office skills, including PowerPoint and Advanced Excel skills with knowledge of pivot tables, Power Queries, and complex formulas
- Superior written and verbal communication skills
- Possess a positive attitude and a willingness to learn
- Ability to work well under pressure by efficiently prioritizing and managing multiple tasks to meet performance expectations and deadlines
- Strong critical thinking and analytical skills
- Experience in analyzing and interpreting reports for financial trends in the provider contracting arena
- Self-motivated and team-oriented
- Great experience working with CPT and ICD-10 codes
- Exceptional customer service skills with a professional, businesslike image to clients, visitors, internal staff, and the public
- Currently eligible to work in the U.S. without any assistance in getting a U.S. employment visa or work authorization.
Preferences – Not Required
- Experience with Cactus, practice management system(s), and SSQ or other reporting systems
- Cardiology specialization experience
Physical Demands
This role involves a mix of desk work and light physical activity. You’ll regularly sit, communicate, and handle objects, tools, or controls, as well as reach with your hands and arms. The role requires the ability to see details up close and adjust focus as needed. The ability to lift and carry up to 20 pounds, push/pull up to 25 pounds, and stand or walk for periods throughout the day is required. Reasonable accommodations are available for qualified individuals with disabilities.
Your Future Working Environment
If you join Cedar Gate, you can make great ideas happen for some of the world's most dynamic companies. With broad global resources and deep technical know-how, we collaborate with clients to cultivate ideas and deliver results in the medical industry. Choose a career at Cedar Gate and enjoy an innovative environment where challenging and interesting work is part of daily life.
Next to our excellent terms of employment and fringe benefits, we invest considerable resources to provide ongoing training that builds and extends professional, technical, and management skills in all areas. At Cedar Gate, you will operate in a professional environment where teamwork and innovation are immensely encouraged. Together with colleagues, you will work on high-impact projects for many dynamic companies.
About Cedar Gate
Cedar Gate enables payers, providers, employers, and service administrators to excel at value-based care. Our unified technology and services platform enhances and automates data management activities to deliver employer and provider analytics, care management, and payment technology necessary to pursue every payment model and optimize performance in all lines of business. From primary care attribution to bundled payments to capitation, our platform is designed to improve clinical, financial, and operational outcomes for all.
Based in Greenwich, CT, Cedar Gate is private equity backed by GTCR, a leading Chicago-based private equity firm, Ascension Ventures, a strategic healthcare venture firm, and Cobalt Ventures, the investment subsidiary of BCBS of Kansas City. To learn more, visit www.cedargate.com.