Managed Care Contracting and Performance Advisor
New
J
JobgetherHealthcare finance
Full-time remote work from within the United StatesFull-TimeSenior
SalaryAnnual salary range of $113,000–$188,000, depending on experience, qualifications, skills, training, and organizational considerations. Potential eligibility for a discretionary variable incentive bonus.
Apply NowOpens the employer's application page
Job Details
- Experience
- Bachelor's degree with at least 6–8 years of relevant professional experience, or an associate degree with at least 8–10 years of relevant experience. Equivalent relevant experience may be considered in place of formal education.
- Required Skills
- Microsoft ExcelPowerPoint
Requirements
- Hold a bachelor's degree with 6–8 years of relevant professional experience, or an associate degree with 8–10 years of relevant experience; equivalent relevant experience may substitute for formal education.
- Have experience in healthcare provider organizations, managed care, contracting, healthcare finance, payer relations, healthcare administration, or revenue cycle outsourcing.
- Demonstrate experience reviewing, evaluating, or negotiating healthcare agreements, preferably with commercial insurers and government-sponsored health plans.
- Have experience with financial analysis, reimbursement evaluation, contract assessment, and financial modeling.
- Understand hospital and physician reimbursement methodologies, including Medicare, Medicaid/Medi-Cal, DRGs, APCs, fee schedules, capitation, and value-based payment models.
- Be able to interpret complex contractual provisions and translate them into practical implementation requirements.
- Apply quantitative and problem-solving skills to evaluate payer proposals, assess reimbursement trends, forecast financial impact, and identify revenue improvement opportunities.
- Bring negotiation and relationship-management skills for working with payer representatives and internal stakeholders.
- Coordinate contract implementation, manage competing priorities, meet deadlines, and drive initiatives from analysis through execution.
- Communicate financial and contractual information through written reports, presentations, and executive-level recommendations.
- Be proficient in Microsoft Excel and PowerPoint and have experience with healthcare financial analytics and reporting tools.
Responsibilities
- Review and audit managed care agreements to identify opportunities to improve reimbursement, contract terms, compliance, and renegotiation outcomes.
- Build financial models to assess proposed rate changes, contract amendments, payer arrangements, and alternative reimbursement structures.
- Interpret contract language, reimbursement methodologies, payment policies, authorization requirements, and contractual obligations to identify risks.
- Develop contracting strategies, business cases, financial assessments, and executive-level recommendations.
- Prepare payer negotiation proposals and data-supported counterproposals for commercial insurance plans, Medicare Advantage, Managed Medicaid, and other managed care organizations.
- Coordinate implementation of new and amended agreements with Finance, Revenue Cycle, Patient Access, Case Management, Physician Services, and other stakeholders.
- Develop contract summaries, reimbursement guides, reference materials, and educational resources for operational teams.
- Monitor reimbursement accuracy, payment timeliness, denial trends, underpayments, payment variances, and revenue yield.
- Investigate and escalate underpayments, denials, payment discrepancies, and contractual disputes.
- Prepare executive reports and presentations on contract performance, negotiation progress, financial outcomes, and strategic recommendations.
View Full Description & ApplyYou'll be redirected to the employer's site
