Managed Care Analyst

Managed Care Analyst

About the Company:

Wellstart Medical was founded in 2019 to improve diabetes care. Wellstart (“the Company”) is a direct-to-consumer provider of continuous glucose monitors, insulin pump supplies, and other diabetes testing supply products. The Company provides patients with education, support, and access to a fast, simple, and reliable way to obtain diabetes supplies on a recurring basis.

Position:

The Managed Care Analyst at a durable medical equipment (DME) provider plays a vital role in analyzing managed care contracts, optimizing reimbursement strategies, and managing payer credentialing processes. This position specializes in Managed Medicare and Medicaid plans, ensuring compliance with payer requirements while identifying opportunities to enhance revenue cycle performance. The analyst provides data-driven insights to improve financial outcomes, streamline operational processes, and strengthen relationships with Medicare Advantage (MA) and Medicaid Managed Care Organizations (MCOs).

Responsibilities:

• Analyze Managed Medicare and Medicaid reimbursement trends, provide actionable insights, identify and contract target scopes to enhance collections and cash flow.
• Conduct in-depth analysis of Managed Medicare and Medicaid contracts, ensuring adherence to terms and conditions.
• Identify opportunities for improved reimbursement rates, fee schedules, and reduction of claim denials.
• Support contract negotiations by leveraging data analytics and payer trends.
• Manage credentialing and re-credentialing processes for state Medicaid enrollments, Managed Medicare and Medicaid payers, ensuring accurate and timely submission of required documentation.
• Serve as a liaison between the company and Managed Medicare & Medicaid organizations, ensuring strong payer relationships.
• Address and resolve payer issues, contract disputes, and reimbursement concerns with Medicare Advantage Plans, Medicaid MCOs, and third-party administrators (TPAs).
• Monitor federal and state policy updates that impact Managed Medicare and Medicaid reimbursement and compliance.
• Educate internal teams on Managed Medicare and Medicaid billing requirements, contract provisions, and reimbursement policies.
• Stay informed on regulatory changes, payer medical policies, and industry trends related to managed care and credentialing.
• Maintain strict confidentiality and exercise sound judgment while handling sensitive and confidential information.
• Adhere to ethical standards and organizational policies to ensure the protection of proprietary and personal data.

Please Note: The list of responsibilities detailed above is not exhaustive, nor is it intended to be a list of all responsibilities and duties of the Credentialing and Licensing Specialist. The responsibilities and duties are subject to addition or change at any time.

Education and Experience:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field (preferred education)
• 5 years’ experience in managed care contracting and provider credentialing in DME or healthcare services.
• Strong knowledge of Medicare Advantage (MA) plans, Medicaid Managed Care Organizations (MCOs), and their reimbursement structures.
• Proficiency in data analysis, payer performance tracking, and contract negotiation.
• Familiarity with Medicare and Medicaid billing processes, prior authorization workflows, and claim adjudication.
• Ability to work cross-functionally with billing, compliance, revenue cycle, and payer relations teams.
• Strong analytical skills, attention to detail, and ability to interpret complex contracts and payer policies.
• Proficiency in Excel and other data analysis tools.
• Excellent communication and collaboration abilities.

Pay Range

The base salary is determined by various factors, including professional background, training, work experience, location, business needs, and market demand. As a result, the actual salary may occasionally fall outside the anticipated range. This pay range is subject to future adjustments. Additionally, this position qualifies for a discretionary annual bonus, paid time off, and a comprehensive benefits package, which includes company-sponsored medical, dental, vision coverage, and a 401(k) plan.

Job Type: Full-time

Pay: $60,000.00 - $80,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• Do you have at least 5 years of experience in managed care contracting and provider credentialingt?

Location:

• Florida (Preferred)

Work Location: Remote

Salary : $60,000 - $80,000