Managed Care Specialist

Job Summary

A company is looking for a Managed Care Specialist who optimizes managed care reimbursement through analysis and support during the contracting process.

Key Responsibilities

• Manage Single Case Agreements with non-contracted payers, ensuring compliance with negotiated terms
• Provide reconciliation and training regarding payments, auditing large and complex cases for adherence to payer agreements
• Conduct managed care analysis and audits, resolving discrepancies and evaluating low pay situations

Required Qualifications

• Bachelor's degree in a relevant field
• No licensure or certification required
• No additional experience required for candidates with a Bachelor's degree
• Four (4) years of experience with managed care contracts, data analysis, or provider relations for Associate's degree holders
• Eight (8) years of experience with managed care contracts, data analysis, or provider relations for High School diploma or GED holders