Managed Care Contract Specialist

16 hours ago

Greenville, South Carolina, United States Ob Hospitalist Group Full time
Job Title: Managed Care Contract Analyst/Provider Relations

Ob Hospitalist Group is seeking a highly skilled Managed Care Contract Analyst/Provider Relations professional to join our team. As a key member of our contracting team, you will be responsible for developing and maintaining strong relationships with payors, negotiating contracts, and ensuring compliance with regulatory requirements.

Key Responsibilities:
  • Develop and implement a network development strategy for existing or new programs, including researching payors and obtaining agreements.
  • Summarize contracts by completing contract summary sheets with relevant information from contract language, payer contract representatives, and payer websites.
  • Maintain fee schedules in ECHO and Excel, update them annually, and load them into the CHC variance tool to identify trends and research variances.
  • Lead ongoing maintenance and auditing of contract management rate calculations.
  • Makes independent decisions on contracting rates for new agreements and renegotiated agreements based on existing rate information.
  • Link new locations/programs to existing state contracted payors as needed.
  • Develop and maintain Echo Reports, including rosters, Onboarding Report, and Payer lists by state, coordinating with vendors when necessary.
  • Maintain training material for new hires and contracting files, including the OBHG contracting database.
  • Develop and maintain reports and/or spreadsheets to document contracting leads and workflow.
  • Be the point of contact for RCM issues with Health Plans/Payers, making independent decisions and coordinating with Health Plans to resolve escalated claims issues.
Requirements:
  • 5+ years of managed care contracting/provider relations experience in healthcare.
  • Strong Revenue Cycle Management analytical and reporting skills.
  • General knowledge of Revenue Cycle Management as it pertains to Accounts Receivable, Credentialing, and EDI/EFT.
  • Knowledge of contracting language and negotiation principles.
  • Strong understanding of Managed Care, Credentialing, and Accounts Receivable.
  • Strong critical thinking skills and ability to identify process improvement possibilities.
  • Strong organizational skills and attention to detail.
  • Strong computer skills, proficient in Word and Excel.
Preferred Qualifications:
  • Bachelor's degree in business administration, accounting, finance, healthcare, or related field, and/or equivalent work experience.
  • Familiarity with managed care, State, and/or Federal healthcare programs.
  • Previous history of analytics experience.
What We Offer:
  • A mission-based company with an amazing company culture.
  • Paid time off and holidays to spend with loved ones.
  • Medical, dental, and vision insurance for you and your loved ones.
  • Health Savings Account (with employer contribution) or Flexible Spending Account options.
  • Paid Parental Leave.
  • Employer-paid Basic Life and AD&D Insurance.
  • Employer-paid Short- and Long-Term Disability.
  • Optional Short-Term Disability Buy-up plan.
  • 401(k) Savings Plan, with ROTH option.
  • Legal Plan.
  • Identity Theft Services.
  • Mental health support and resources.
  • Employee Referral program.

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