Managed Care Specialist

This is a fully remote position, open to applicants in Alabama, +32 more states.

📋 Description

• Oversees the administration of the designated segment of the contract portfolio.

• Maintains an in-depth understanding of assigned payor contracts and manages the administration and compliance of managed care contracts.

• Develops and maintains electronic databases and original permanent files for contract documents.

• Communicates and educates operational teams on the implementation of new contract terms that impact revenue cycle functions.

• Manages the execution of new or renegotiated managed care agreements.

• Ensures secure distribution of confidential contract documents and communicates contract modifications to executives and revenue cycle staff.

• Monitors, reports, resolves, and prevents operational challenges related to existing managed care contracts.

• Collaborates with revenue cycle personnel and MCO provider relations to address operational issues.

• Acts as an advisor and main point of contact for revenue cycle staff on managed care operational and administrative matters.

• Supports designated colleagues and Managed Health Resources Provider Services in operational functions.

• Initiates and leads Joint Operating Committee meetings with MCOs and internal issue-resolution discussions.

• Organizes meetings, prepares agendas, generates performance reports, and distributes meeting minutes.

• Reviews payor websites and external resources to remain informed about payor policies and initiatives.

• Composes clear and concise internal communications and correspondence.

• Identifies data sources, conducts analyses, and applies methodologies under supervision.

⛳️ Requirements

• Full-time, dayshift Monday to Friday.

• Fully remote position available in the following states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.

• No relocation assistance or visa sponsorship is available for this position, now or in the future.

• An Associate's degree or equivalent experience is required.

• A minimum of two years of experience in managed care contracting, operations, or patient financial services within a large healthcare provider or managed care organization.

• Experience in preparing, processing, and tracking formal business correspondence and contract notifications, including time-sensitive mail and electronic communications.

• Strong research and analytical abilities, with a knack for identifying discrepancies and resolving issues.

• Experience managing multiple projects, deadlines, work queues, or high-volume administrative tasks.

• Licensure, Registration, and/or Certification: None Required.

• Capability to work under standard office conditions, including prolonged sitting, standing, walking, repetitive wrist/arm motions, or lifting items up to twenty-five pounds.

🏝️ Benefits

• Eligible for benefits.

• Competitive compensation package.

• Premium pay options such as shift differentials and on-call pay based on the teammate's role.

• Incentive pay available for select positions.

• Potential for annual salary increases based on performance.

• Paid Time Off programs.

• Health and welfare benefits including medical, dental, vision, life insurance, and Short- and Long-Term Disability coverage.

• Flexible Spending Accounts for eligible healthcare and dependent care expenses.

• Family benefits including adoption assistance and paid parental leave.

• Defined contribution retirement plans with employer matching and additional financial wellness programs.

• Educational Assistance Program.

• Fully remote position.

• Monday–Friday dayshift schedule.