Managed Care Contracting Specialist

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

📋 Description

• Evaluate, analyze, and renegotiate DME and IDTF contracts to ensure alignment with organizational objectives and industry standards

• Guarantee that agreements adhere to federal, state, and payer regulations

• Discover opportunities for cost efficiency and enhanced service delivery through contract optimization

• Prepare, assess, and finalize Letters of Agreement (LOAs) for unique arrangements or exceptions

• Address billing and payment concerns with providers not under contract

• Track contract performance, reimbursement trends, and changes in regulations

• Deliver reporting and strategic insights to management

• Cultivate provider relationships

• Supervise the development and management of LOAs that support operational and financial goals

⛳️ Requirements

• Associate degree or equivalent, or 3+ years of experience in managed care, payer relations, or healthcare sales, ideally in DME or IDTF

• Comprehensive knowledge of payer contracting, reimbursement methods, and healthcare regulations

• Outstanding negotiation, communication, and relationship-building abilities

• Proficient in CRM and contract management software

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

• Capability to operate office equipment pertinent to job responsibilities

• Preferred: Experience working with Medicare Advantage, Medicaid MCOs, and commercial payers to secure LOAs

• Preferred: Knowledge of HCPCS coding and billing practices for DME and diagnostic services

• Preferred: Skill in interpreting and clarifying clinical documentation to payers

🏝️ Benefits

• Opportunities for career advancement within an international organization

• Complimentary medical coverage in the Health Investment Plan (HIP) PPO medical plan for eligible employees in the upcoming calendar year

• Retirement savings plan featuring a significant employer contribution

• Tuition reimbursement program

• Freedom 2 Save student debt initiative

• FreeU education benefit, providing a pathway to earning a bachelor’s degree

• Health and wellness programs

• Equal Opportunity Employer dedicated to fostering employee diversity