Managed Care Contracting Manager

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

📋 Description

• Assist leaders in Home Health, Hospice, Private Duty, and Senior Living Facilities with managed care contracting and strategies for revenue enhancement.

• Negotiate rates and terms for managed care payer contracts.

• Foster managed care relationships and negotiate contracts for new sites.

• Revise contracts to include new services and handle contract terminations.

• Collaborate with Legal and Finance teams to analyze contract terms, rates, margins, risks, and benefits.

• Plan and execute tactical strategies to support the expansion into managed care relationships.

• Identify, cultivate, and sustain relationships with managed care payers and healthcare regulatory bodies.

• Provide training and guidance to Field Operations partners.

• Keep track of industry developments and market trends to uncover opportunities for increasing and safeguarding managed care revenue.

• Address issues such as contract cancellations, denials, and appeals.

• Act as the internal expert on managed care for operational and Service Center leadership.

• Educate and advise operational leadership on managing managed care contracts.

• Support Accounts Receivable teams with complex managed care claims issues and projects.

• Share essential contract terms and rates for both new and ongoing managed care payer contracts.

⛳️ Requirements

• Preferred Bachelor’s degree in business administration, management, or healthcare administration.

• At least 5 years of experience in managed care contracting within a managed care payer or provider organization.

• Familiarity with the managed care landscape, including Medicare Advantage, Commercial, and Managed Medicaid products.

• Understanding of Accountable Care Organizations and value-based purchasing strategies.

• Knowledge of managed care payer contract language, terms, standard requirements, and rate negotiation methodologies.

• Strong skills in analysis, problem-solving, critical thinking, prioritization, planning, and multitasking.

• Ability to articulate complex financial concepts clearly and professionally.

• Exceptional verbal and written communication skills with a keen attention to detail.

• Commitment to maintaining confidentiality and adhering to HIPAA regulations.

• Familiarity with operations in Home Health, Hospice, Private Duty, and Assisted Living Facilities is advantageous.

• Understanding of CPT-4, HCPCS, Revenue, and ICD coding.

• Proficient in computer applications, including MS Word, MS Outlook, and Excel; knowledge of Smartsheet is a plus.

• Capability to work cooperatively, flexibly, and adaptively in a fast-paced environment.

• Willingness to travel as needed.

🏝️ Benefits

• Opportunities for personal and professional growth.

• Commitment to equal opportunity employment.

• Travel opportunities related to the position.