Managed Care Contract Specialist

1 week ago


Lansing, Michigan, United States Highmark Health Full time
Job Summary

We are seeking a highly skilled Managed Care Contract Specialist to join our team at Highmark Health. As a key member of our Revenue Cycle team, you will be responsible for building and maintaining hospital, professional, and ASC contracts in Epic. Your expertise in contract negotiation and analysis will enable you to identify underpaid accounts and articulate the source of the processing error to payors.

Key Responsibilities
  • Contract Building and Maintenance: Provide support to senior analysts in building hospital, professional, and ASC contracts in Epic, with a focus on ensuring accurate and timely contract execution.
  • Underpayment Recovery: Manage underpayment AR for assigned payors, including successfully recovering on underpaid accounts and articulating the source of the processing error to payors.
  • Collaboration and Analysis: Collaborate with Revenue Cycle and Finance Teams on contract building and analysis requests, providing expert analysis and insights to inform business decisions.
  • Additional Responsibilities: Perform other duties as assigned or required, including providing assistance in performing analyses to support reimbursement impact analysis.
Requirements
  • Education: Associate's degree in Finance, Accounting, Business Administration, Economics, Statistics, or Related Field.
  • Experience: Experience in finance, contracting, or data analysis, with a strong understanding of healthcare reimbursement methodologies.
  • Skills: Microsoft Office (Excel, PowerPoint, etc.), ability to analyze and interpret various types of data, and strong oral and written communication skills.
Preferred Qualifications
  • Education: Bachelor's degree in Finance, Accounting, Business Administration, Economics, Statistics, or Related Field.
  • Experience: Experience with hospital, physician, and ASC contracts, as well as experience in healthcare.
  • Skills: Epic Expected Reimbursement Contracts Certification, R, Python, or other statistical/programming tools, and knowledge of healthcare industry reimbursement methodologies.

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.



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