Managed Care Contracting Specialist

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

📋 Description

• Review, assess, and renegotiate DME and IDTF contracts to ensure alignment with the organization's objectives and industry standards.

• Ensure all contracts adhere to federal, state, and payer regulations.

• Identify avenues for cost reduction and enhanced service delivery through contract optimization.

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

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

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

• Provide reporting and strategic insights to the leadership team.

• Manage relationships with providers and oversee the creation and administration of LOAs.

⛳️ Requirements

• Associate degree or equivalent experience, or at least 3 years in managed care, payer relations, or healthcare sales, preferably within DME or IDTF.

• Strong knowledge of payer contracting, reimbursement methods, and healthcare regulations.

• Exceptional 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.

• Experience with Medicare Advantage, Medicaid MCOs, and commercial payers for obtaining LOAs (preferred).

• Familiarity with HCPCS coding and billing practices related to DME and diagnostic services (preferred).

• Ability to interpret and clarify clinical documentation for payers (preferred).

🏝️ Benefits

• Career advancement opportunities with an international company that supports your professional aspirations.

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

• Outstanding retirement savings plan with significant employer contributions.

• Tuition reimbursement support.

• Freedom 2 Save program for student debt reduction.

• FreeU education benefit — a cost-effective and convenient route to earning a bachelor’s degree.

• Health and wellness benefits.

• Commitment to equal employment opportunities and employee diversity.