MANAGED CARE SPECIALIST

Purpose

The Managed Care Specialist will facilitate healthcare business operations by ensuring timely and organized execution of provider network participation, contracting, and onboarding information. This role will support loading of provider agreements, gathering information for financial or operational onboarding, and contract inquiries to streamline processes and enhance overall efficiency in provider and contracting operations. The incumbent will collaborate with external partners such as hospital systems, physicians, allied health providers, healthcare vendors, as well as internal partners such as provider relations, patient services, claims, and other teams to coordinate back-office operations related to insurance setup.

Duties

• Provider Enrollment and Onboarding: Build and maintain positive relationships with healthcare providers, including physicians, specialists, and facilities. Serve as a liaison to facilitate and direct inquiries pertaining to their contractual relationship with the Funds. 
• Provider Network Development & Maintenance: Assist in onboarding new providers to the provider network. Ensure the accuracy of provider information in our systems, and maintain up-to-date records of contracted agreements and terms. Addresses operational issues and ensures contract rates and contract terms are implemented.
• Contract Adherence: Monitor and ensure adherence with the terms and conditions of managed care contracts, including reimbursement rates, service guidelines, and approval processes. Work with internal teams and external stakeholders as appropriate to address discrepancies or breaches in contract obligations. Gains operational knowledge of contractual agreements and specific contractual language between the organization and providers.
• Collaboration with Providers & Insurance Partners: Serve as a point of contact for healthcare providers, helping them understand and navigate managed care contract terms. Collaborate with insurance carriers to ensure smooth communication and resolution of issues related to patient care, benefits, and professional services.
• Documentation & Reporting: Maintain accurate documentation of provider agreements and related correspondence.
• Education & Support: Educate providers on contract terms, reimbursement processes, and managed care requirements. Provide ongoing support to both providers and internal teams to ensure all parties are informed with the most up-to-date information. 
• Performs other duties as requested.

Job Qualifications

• Associate Degree or Other Formal Training in business administration or healthcare related field, or equivalent combination of education and related experience are required. 
• 0-3 years of relevant healthcare industry experience, with an emphasis on managed care. 
• Strong written and oral (presentation) skills. 
• Detail oriented and demonstrated organizational skills. 
• Ability to work both independently and in a team environment. 
• Flexibility to handle rapidly changing priorities. 
• Ability to prioritize and handle multiple tasks in a demanding work environment.
• Understanding of the insurance environment, including, but not limited to, insurance policies and procedures, reimbursement mechanisms, billing principles and practice management procedures. 
• PC proficiency to include Microsoft Office

Compensation and Benefits

• Medical, Dental, Vision, Pharmacy, and Mental health benefits at no cost to all benefits-eligible employees and their eligible dependents
• Paid Time Off (Vacation, Personal, Sick days, and 12 paid Holidays)
• 401(k) Plan with employer contribution
• Life Insurance
• Tuition Reimbursement
• Short Term and Long-Term Disability Benefits 
• Legal Services
• Wellness Benefits