Managed Care Contracting Specialist

This is a fully remote position, open to applicants in California, +1 more state.

📋 Description

• Review, evaluate, and renegotiate DME and IDTF contracts to ensure alignment with organizational objectives and market standards.

• Ensure that agreements adhere to federal, state, and payer regulations.

• Identify potential cost-saving opportunities and enhancements in service delivery through the optimization of contracts.

• Draft, assess, and finalize Letters of Agreement (LOAs) for special arrangements or exceptions.

• Address billing and payment concerns with non-contracted providers.

• Monitor contract performance, reimbursement trends, and changes in regulations.

• Provide strategic insights and reporting to leadership.

• Manage relationships with providers.

⛳️ Requirements

• An associate degree or equivalent experience, or a minimum of 3 years in managed care, payer relations, or healthcare sales, preferably within DME or IDTF.

• Strong comprehension of payer contracting, reimbursement methodologies, and healthcare regulations.

• Exceptional negotiation, communication, and relationship-building abilities.

• Proficiency in CRM and contract management systems.

• Willingness to participate in job-related courses and seminars as necessary.

• Capability to operate office equipment relevant to job duties.

• Preferred: Experience with Medicare Advantage, Medicaid MCOs, and commercial payers for obtaining LOAs.

• Preferred: Knowledge of HCPCS coding and billing practices related to DME and diagnostic services.

• Preferred: Ability to interpret and clarify clinical documentation for payers.

🏝️ Benefits

• Opportunities for career advancement within an international company.

• Eligibility for free medical coverage through the Health Investment Plan (HIP) PPO medical plan in the upcoming calendar year.

• Retirement savings plan featuring a substantial employer contribution.

• Tuition reimbursement program.

• Freedom 2 Save program for student debt relief.

• FreeU educational benefit towards obtaining a bachelor’s degree.

• Comprehensive health and wellness benefits.