Job Requirements
The Senior Managed Care Contracting Specialist is responsible for the implementation, monitoring, and ongoing administration of managed care payer contracts. The Senior Managed Care Contracting Specialist provides proactive leadership for managed care operations and Joint Operating Committees (JOCs) while supporting contract performance, education, and service excellence across Health First’s Managed Care relationships.
The Senior Managed Care Contracting Specialist’s responsibilities include constructing and educating on negotiated contract terms, ensuring accurate implementation of reimbursement rates, and necessary operational changes, while providing project leadership, and supporting internal and external managed care stakeholders. The Senior Managed Care Contracting Specialist supports employed and community providers, associates, hospitals, payers, employers and patients.
The Senior Managed Care Contracting Specialist partners with contracted payers and related entities to resolve issues, promote compliance, support seamless implementation, strengthen education, and drive best-in-class contract performance. The Senior Managed Care Contracting Specialist serves as the liaison and subject matter expert for managed care JOCs and contract databases. PRIMARY ACCOUNTABILITIES Interprets contract language and ensures contract and reimbursement terms are communicated clearly and implemented accurately in systems and operations.
Leads all Managed Care Joint Operating Committees and serves as the subject matter expert and escalation point for complex managed care issues across internal and external departments. Reviews and evaluates payer reimbursement for compliance with contract terms and enforces agreements when discrepancies arise. Maintains all Managed Care contract databases and files.
Ensures payer policies are reviewed proactively, escalated to leadership, and analyzed for operational impact before implementation. Supports Health First’s managed care contracting by analyzing data and contract terms to recommend market-appropriate rates and compliant, protective language. Aids department leaders with complex projects, task management, and departmental goals.
Builds new relationships and maintains existing partnerships with major insurers, provider networks, and federal and state entities. Participates in and recommends policies and procedures that optimize operational workflows and contract performance. Serves as a liaison with internal departments on the Health System’s participation status with insurance companies and payers.
Assists credentialing and provider enrollment activities as needed. Work Experience
Any one of the following: Bachelor’s degree Current enrollment in Bachelor's degree program Work Experience in Lieu of
5 years of experience in relevant health care environments. • Work
Any one of the following: o Two (2) years’ Managed Care experience with another provider organization OR o Two (2) years’ experience in network relations role with an insurance company, OR o Four (4) years’ experience in a revenue cycle role including registration, patient accounts, coding, revenue integrity and other functions that that have exposure to processing payer related policies. •
- None
- Certification: None
- Skills/Knowledge/Abilities: o Proficient in Microsoft Office – Outlook, Word, Excel, PowerPoint, Teams. o Familiar with Epic systems. o Knowledge of reimbursement methodologies and payment mechanisms o Strong critical thinking skills, communication and presentation skills, as well as a professional presence. o Excellent research ability, excel skills, and quick learner with the ability to apply logic and common sense to complex problem resolution. o Ability and initiative to work autonomously with minimal supervision. o Able to work with multiple stakeholders, at all levels, including internal and external clients, to ensure exceptional delivery of services. o Thorough understanding of multiple hospital and professional related services
Bachelor’s or Master’s degree • Work
- o Five (5) years’ Managed Care experience with another provider organization, or in a role around network relations for an Insurance Company. o Experience in revenue cycle management focused on analyzing, communicating and resolving broad issues.
- Skills/Knowledge/Abilities: o High level understanding of multiple Hospital and professional related reimbursement methodologies and payment mechanisms. o Expert skill level in Microsoft Office – Outlook, Word, Excel, PowerPoint, Teams o Familiar with using Ntracts contract management. o Strong critical thinking, verbal and written communication skills, and professionalism. o Detail oriented and well organized. o Ability to apply logic and common sense to complex problem resolution. o Demonstrates initiative, works efficiently, and is committed to accuracy. o Ability to work on multiple projects, in a fast-paced environment. o Time management skills with ability to set priorities and reprioritize as needed. PHYSICAL REQUIREMENTS
- Majority of time involves sitting or standing; occasional walking, bending, and stooping.
- Long periods of computer time or at workstation.
- Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
- May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
- Communicating with others to exchange information.
- Visual acuity and hand-eye coordination to perform tasks.
- Workspace may vary from open to confined.
- May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle Benefits ABOUT HEALTH FIRST At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.
Full-Time Shift Times : 900am_530pm Paygrade : PG-36