Managed Care Contract Specialist

4 weeks ago

Stafford, United States Memorial Hermann Health System Full time

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Responsible for building, loading, testing and maintaining hospital third-party payer contracts in the contract modeling system. Accountable for analyzing relevant data and translating into reporting to support necessary determinations of adjustment to ensure maximization of values for contract negotiation purposes, and ultimately final agreed reimbursement, meeting System financial and operational expectations. Participates in active third-party payer negotiation discussions representing modeling work product through necessary iterations of rate modeling and analysis.Job Description

MINIMUM QUALIFICATIONS

Education: Bachelor's degree in Business Administration, Finance, or Accounting preferred.

Licenses/Certifications: Required to complete training and become certified in the applicable EPIC applications within the first 90 days of employment to include Resolute Hospital Billing Expected Reimbursement Contracts Administration.

Experience / Knowledge / Skills:

  • Three (3) years' experience in hospital contract modeling required (preferably in Payment Integrity Compass (PIC) or Epic).
  • Effective oral and written communication skills.
  • Ability to analyze, problem solve and apply critical thinking in a fast-paced environment.
  • Strong organizational skills with the competency to work independently as well as part of a team, and prioritize responsibilities.
  • Must possess proficient Excel skills (i.e. pivots, v-lookup functions).
PRINCIPAL ACCOUNTABILITIES
  • Accurately loads, tests, and maintains executed hospital contracts in the contract modeling system, which subsequently flows into System financial adjustments, netting accounts receivable at time of billing.
  • Performs prospective modeling of proposed contracts, rate structure/value scenarios, and other changes impacting reimbursement to support payer negotiations in addition to daily operations.
  • Analyzes and determines the financial impact of government (federal and state) and commercial fee schedule/reimbursement changes to develop proposed adjustments (what if scenarios) to support negotiations.
  • Loads and maintains hospital contract reimbursement and terms in an internal database for applicable user and vendor accessibility.
  • Generates standard and ad-hoc reporting allowing for critical decision-making specific to hospital reimbursement and associated impacts.
  • Supports Managed Care Contract Administrators with identification of opportunities, risks, errors, etc. in payer reimbursement proposals and counter-proposals for comprehensive value review and accuracy.
  • Serves as a Subject Matter Expert (SME) in conjunction with the Managed Care Contract Administrator relevant to facility and/or professional contract reimbursement.
  • Collaborates with the Revenue Cycle, Finance, Government Reporting and various other internal stakeholder departments to address contract variances, discrepancies, and contributes as appropriate in other third-party payer contract reimbursement related projects.
  • Works collaboratively with external System vendors regarding contract audit activities and various third-party payer reimbursement related matters.
  • Identifies potential process improvement opportunities, initiating projects to improve internal operations.
  • Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann System policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
  • Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann's service standards by providing safe, caring, personalized and efficient experiences to patients and our workforce.
  • Other duties as assigned.

  • Contracts Manager

    4 weeks ago

    Stafford, United States Alexandria Insights Full time

    Job DescriptionJob DescriptionContracts Manager-Stafford, VAAlexandria Insights is a growing small business government contractor, seeking a Contracts Manager to support our growing business portfolio in Stafford, VA.    The ideal candidate will be experienced in handling a wide range of contracting duties to include contract negotiation and...

  • Junior Contracts Support Specialist

    2 months ago

    Stafford, United States X Corp Solutions Inc. Full time

    **General Qualifications** Provide basic professional contracts support. This candidate will systematically and effectively assist the Contracts Manager in the management, creation, and execution of contracts to maximize financial and operational performance and minimize risk. The candidate will assist in the compliance with terms are met, as well as...

  • Junior Contracts Support Specialist

    1 week ago

    Stafford, United States X Corp Solutions Inc. Full time

    **General Qualifications** Provide basic professional contracts support. This candidate will systematically and effectively assist the Contracts Manager in the management, creation, and execution of contracts to maximize financial and operational performance and minimize risk. The candidate will assist in the compliance with terms are met, as well as...

  • Journeyman Budget Specialist

    4 weeks ago

    Stafford, United States Culmen International LLC Full time

    **Culmen Overview** Established in 2004, Culmen International is committed to enhancing international security, strengthening homeland defense, optimizing government operations and providing humanitarian assistance around the world. We provide technical and management expertise, develop innovative technology solutions, and deliver youth care services,...

  • Administrative Specialist

    1 month ago

    Stafford, United States Bering Straits Native Corporation Full time

    Overview Visit our website at to apply! SUMMARY Arcticom, LLC, a subsidiary of Bering Straits Native Corporation is currently seeking a qualified Administrative Specialist for the Ground Based Air Defense Engineering and Logistics Contract at Quantico, VA.The  Administrative Specialists will perform numerous administrative tasks while supporting the...

  • Accounts Receivable Specialist

    4 weeks ago

    Stafford, United States Addison Group Full time

    Role: Accounts Receivable Specialist Location: Houston, TX Pay Rate: $30/hour Internal Job ID: 10025337 We are looking for an Accounts Receivable Specialist! Our client in Houston, Texas is seeking an AR Specialist on a contract-to-hire basis. Responsibilities: •Process full cycle accounts receivable. •Handle invoicing and billing. •Process cash...

  • Accounts Receivable Specialist

    4 weeks ago

    Stafford, United States Addison Group Full time

    Role: Accounts Receivable Specialist Location: Houston, TX Pay Rate: $30/hour Internal Job ID: 10025337 We are looking for an Accounts Receivable Specialist! Our client in Houston, Texas is seeking an AR Specialist on a contract-to-hire basis. Responsibilities: •Process full cycle accounts receivable. •Handle invoicing and billing. •Process cash...

  • Accounts Receivable Specialist

    4 weeks ago

    Stafford, United States Addison Group Full time

    Role: Accounts Receivable Specialist Location: Houston, TX Pay Rate: $30/hour Internal Job ID: 10025337 We are looking for an Accounts Receivable Specialist! Our client in Houston, Texas is seeking an AR Specialist on a contract-to-hire basis. Responsibilities: •Process full cycle accounts receivable. •Handle invoicing and billing. •Process cash...

  • Accounts Receivable Specialist

    1 month ago

    Stafford, United States Addison Group Full time

    Job DescriptionJob DescriptionRole: Accounts Receivable SpecialistLocation: Houston, TXPay Rate: $30/hourInternal Job ID: 10025337We are looking for an Accounts Receivable Specialist! Our client in Houston, Texas is seeking an AR Specialist on a contract-to-hire basis.Responsibilities: · Process full cycle accounts receivable.· Handle invoicing and...

  • Accounts Receivable Specialist

    4 weeks ago

    Stafford, United States Addison Group Full time

    Job DescriptionJob DescriptionRole: Accounts Receivable SpecialistLocation: Houston, TXPay Rate: $30/hourInternal Job ID: 10025337We are looking for an Accounts Receivable Specialist! Our client in Houston, Texas is seeking an AR Specialist on a contract-to-hire basis.Responsibilities: · Process full cycle accounts receivable.· Handle invoicing and...

  • Accounts Receivable Specialist

    4 weeks ago

    Stafford, United States Addison Group Full time

    Job DescriptionJob DescriptionRole: Accounts Receivable SpecialistLocation: Houston, TXPay Rate: $30/hourInternal Job ID: 10025337We are looking for an Accounts Receivable Specialist! Our client in Houston, Texas is seeking an AR Specialist on a contract-to-hire basis.Responsibilities: · Process full cycle accounts receivable.· Handle invoicing and...

  • Logistics Management Specialist, Senior

    4 weeks ago

    Stafford, United States Bowhead Full time

    Overview: Bowhead seeks a Senior Logistics Management Specialist to join our team supporting the Program Office for Logistics Integrated Information Systems Marine Corps (LI2S-MC) in Stafford, VA. The Senior Logistician will work directly with the client analyzing complex and unique technical support assignments and lead or collaborate with engineers,...

  • Logistics Management Specialist, Senior

    4 weeks ago

    Stafford, United States Bowhead Full time

    Overview: Bowhead seeks a Senior Logistics Management Specialist to join our team supporting the Program Office for Logistics Integrated Information Systems Marine Corps (LI2S-MC) in Stafford, VA. The Senior Logistician will work directly with the client analyzing complex and unique technical support assignments and lead or collaborate with engineers,...

  • Evidence Inventory Control and Management Specialist

    1 month ago

    Stafford, United States Vets Hired Full time

    About the job Evidence Inventory Control and Management Specialist PURPOSE: The Evidence Inventory, Control and Management Specialist provides evidence inventory services to properly inventory and maintain the chain-of-custody of all evidence and forensic materials entering the facility. Responsibilities: Receive boxes of casework and related materials. ...

  • Evidence Inventory Control and Management Specialist

    4 weeks ago

    Stafford, United States Vets Hired Full time

    About the job Evidence Inventory Control and Management Specialist PURPOSE: The Evidence Inventory, Control and Management Specialist provides evidence inventory services to properly inventory and maintain the chain-of-custody of all evidence and forensic materials entering the facility. Responsibilities: Receive boxes of casework and related materials. ...

  • Medical Coding Specialist

    7 days ago

    Stafford, United States iMedX, a RapidCare Group company Full time

    Job DescriptionJob DescriptioniMedX is actively recruiting for a Medical Coding Specialist with broad experience in Professional Fee Evaluation & Management coding for both providers as well as facility service lines.  Must have broad-based experience in multiple disciplines with the ability to learn and excel in the application of coding guidelines for...

  • Medical Coding Specialist

    4 weeks ago

    Stafford, United States iMedX, a RapidCare Group company Full time

    Job DescriptionJob DescriptioniMedX is actively recruiting for a Medical Coding Specialist with broad experience in Professional Fee Evaluation & Management coding for both providers as well as facility service lines.  Must have broad-based experience in multiple disciplines with the ability to learn and excel in the application of coding guidelines for...

  • Medical Coding Specialist

    1 day ago

    Stafford, United States iMedX, a RapidCare Group company Full time

    Job DescriptionJob DescriptioniMedX is actively recruiting for a Medical Coding Specialist with broad experience in Professional Fee Evaluation & Management coding for both providers as well as facility service lines.  Must have broad-based experience in multiple disciplines with the ability to learn and excel in the application of coding guidelines for...

  • Naval IT Project Specialist

    3 weeks ago

    Stafford, United States Booz Allen Full time

    Naval IT Project Specialist The Opportunity: As a Naval IT Project Specialist you know the complexities of supporting a project from concept to completion. Many programs require a significant investment of limited resources, and it’s imperative to keep the project on a productive path. That’s why we need you, an experienced Naval IT Project Specialist...

  • Naval IT Project Specialist

    3 weeks ago

    Stafford, United States Booz Allen Full time

    Naval IT Project Specialist The Opportunity: As a Naval IT Project Specialist you know the complexities of supporting a project from concept to completion. Many programs require a significant investment of limited resources, and its imperative to keep the project on a productive path. Thats why we need you, an experienced Naval IT Project Specialist who can...