Contract Specialist, Managed Care

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

📋 Description

• The Contract Specialist plays a crucial role in executing and overseeing nimble’s managed care contracting strategy across multiple states.

• Oversee and maintain precise records for each pending and finalized managed care contract; deliver timely network updates to clients.

• Act as the external negotiator with payers on behalf of healthcare facilities and individual providers, managing all facets of outreach, communication, and contracting logistics.

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

• Formulate clear, actionable recommendations based on your analysis and present your findings directly to the provider client.

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

• Aid in addressing billing or contractual issues with insurance carriers, advocating for the client’s interests.

• Assess, negotiate, and renegotiate 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 with precision and consistency.

• Ensure systematic documentation and version control for all contract files and related payer communications.

• Monitor and interpret regulatory updates, policy changes, and market trends that may impact client reimbursement.

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

⛳️ Requirements

• Strong analytical and critical thinking abilities with a knack for interpreting complex data and transforming it into client-ready insights.

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

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

• Highly organized and detail-oriented; skilled 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.

• A bachelor's degree in Healthcare Administration, Business, Finance, or a related field is preferred.

🏝️ Benefits

• N/A