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Managed Care Contract Specialist

2 months ago

Nashville, Tennessee, United States e CancerCare Full time
Job Summary

We are seeking a highly skilled Managed Care Contract Specialist to join our team at e CancerCare. As a key member of our Managed Care department, you will play a critical role in analyzing and negotiating contracts with healthcare payers to ensure optimal reimbursement rates for our organization.

Key Responsibilities
  • Support the Managed Care team in generating and reviewing system data to inform strategic recommendations.
  • Load and maintain reimbursement rates in our contract management system.
  • Analyze data to provide insights on the impact of adjustments to managed care reimbursement terms and contract compliance.
  • Collaborate with the reimbursement analytic team to ensure accuracy of insurance payments.
  • Develop presentation materials for internal and external meetings.
  • Act as a liaison to assigned business unit meetings and committees.
  • Identify and recommend process improvements for greater operational efficiency.
  • Maintain department spreadsheets and databases.
  • Review managed care payer contracts to ensure proper payment in the Experian tool.
  • Work with payers to resolve contract loading errors identified from audits.
  • Appeal claims and recoup underpaid claims not paid according to the agreement.
Requirements
  • Bachelor's Degree or equivalent experience.
  • Healthcare reimbursement experience in a health system, consulting firm, or with a managed care payer preferred.
  • Advanced knowledge of Microsoft Office tools.
  • Ability to work individually and in a team setting.
  • Strong communication skills.
Preferred Qualifications
  • 3+ years of experience in Managed Care.

e CancerCare is an equal opportunity employer and welcomes applications from diverse candidates. We offer a competitive salary and benefits package. If you are a motivated and detail-oriented individual with a passion for healthcare reimbursement, we encourage you to apply for this exciting opportunity.