Contract Specialist, Managed Care

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute and uphold Nimble’s managed care contracting strategy across multiple states.

• Oversee and maintain precise documentation for both pending and finalized managed care contracts.

• Provide clients with timely updates regarding network developments.

• Act as the external negotiator with payers on behalf of healthcare facilities and individual providers.

• Manage outreach, communication, and logistical aspects of contracting.

• Analyze contract terms, reimbursement models, and financial implications utilizing data models and payer information.

• Create actionable recommendations and deliver findings directly to provider clients.

• Collaborate with clients to grasp their objectives and challenges, customizing negotiation strategies accordingly.

• Aid in the resolution of billing or contractual disputes with insurance carriers.

• Assess, negotiate, and revise managed care contracts with health plans, hospitals/health systems, IPAs, government programs, and other payers.

• Input and verify payer contract terms, rates, and fee schedules into client systems.

• Maintain organized documentation and version control for contract files and payer communications.

• Monitor and analyze regulatory updates, policy shifts, and market trends that influence client reimbursement.

• Assist with client projects, including payer escalations, audits, and strategic network decisions.

• Engage in departmental training and attend staff meetings.

⛳️ Requirements

• Strong analytical and critical thinking abilities to interpret complex data and convert it into insights suitable for clients.

• Proven experience in negotiating with payers externally or functioning as a liaison between payers and providers is highly desirable.

• Exceptional communication and presentation skills — capable of articulating data-driven recommendations to non-technical stakeholders.

• Highly organized and detail-focused; adept at managing multiple priorities and deadlines in a dynamic environment.

• Familiarity with managed care contracts, reimbursement methodologies, and payer systems is strongly preferred.

• Proficient in Excel and financial modeling tools.

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field is preferred.

• Commitment to adhering to all compliance and company policies and procedures.

🏝️ Benefits

• Hybrid or remote work arrangement.

• Participation in departmental training and staff meetings.