Managed Care Contracting Specialist

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

📋 Description

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

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

• Identify potential cost-saving opportunities and enhance service delivery through contract optimization.

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

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

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

• Provide strategic insights and reporting to leadership.

• Manage and nurture relationships with providers.

⛳️ Requirements

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

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

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

• Proficiency in CRM and contract management systems.

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

• Capability to operate office equipment relevant to job functions.

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

🏝️ Benefits

• Career development opportunities with an international organization where you can achieve your career aspirations.

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

• Excellent retirement savings plan featuring a substantial employer contribution.

• Tuition reimbursement program.

• Freedom 2 Save student debt initiative.

• FreeU education benefit - an accessible and convenient route to obtaining a bachelor’s degree.

• Comprehensive health and wellness benefits.

• Equal Opportunity Employer dedicated to fostering employee diversity.