Managed Care Specialist

Job Description

Job Location: Hybrid Remote in our office in Houston, TX

Position Summary

Reasons you will want this position:

We are a rapidly growing company with limitless career growth and advancement for top performers

Our culture appreciates and rewards creative ideas, especially those that achieve better outcomes for everyone

This is an essential position for our continued success and expansion of our Managed Care specialization.

Remote hybrid work schedule with some flexibility with your hours.

Summary

The ideal Managed Care Specialist will leverage a background in provider, payer, and facility contracts to support the department in developing, negotiating, implementing, monitoring, and managing managed care agreements. You will research managed care trends and be responsible for accurate and timely communication of changes that may impact the performance of a contract. As the Managed Care Specialist, you’ll assist in reviewing and analyzing routine reports to determine that contracts are performing according to expected results and distribute accurate information to all departments within the Company. While building and nurturing positive relationships with clients, providers, payers, and internal team members, you will also prepare presentations and, in some cases, participate in or lead those presentations. Even though travel is required for this position, this will be rare.

Roles & Responsibilities

Serve as an internal and external liaison to resolve managed care issues; assist with client, provider, payer, and facility communications; and perform claims research to maintain positive relationships with providers and payers.

Field, manage, and resolve client, provider, and payer support inquiries.

Assist in developing our initiatives by providing analysis and research of managed care trends and benchmarks.

Assist in reviewing and preparing payer and provider agreements and participate in developing negotiation strategies.

Collaborate with other departments requiring contract, payer, and provider information to ensure efficient workflow processes.

Assist with client onboarding related to our payer and provider contracts.

Monitor and contact provider offices for the status of documents; Distribute executed documents to provider offices.

Attend and provide coordination and administrative functions for our various committees.

Track and alert Management of the status of agreements (expiration, changes, notices).

Analyze and track the performance of provider and payer contracts.

Enter, maintain, and validate provider contracting and demographic information in software systems and databases.

Monitor, review, and track payer notices of changes in policies and procedures.

Assist with our Center of Excellence Programs (member education, helpline, enrollment, documentation, account resolution and reporting)

Assist Management and Quality Staff with Clinical Integration provider inquiries, education, and reports

Required Experience / Qualifications

BS/BA in business, finance, or related field required

5+ years’ experience with a healthcare provider, facility, or payer in contracting or business operations, including reporting, managed care contracting, and patient account resolution; cardiology office setting experience a plus

Knowledge of various value-based care reimbursement models

Working knowledge of CPT and ICD-10 codes and medical terminology

Strong computer skills in Microsoft Office (Office 365, Outlook, Excel, Word and PowerPoint)

Strong negotiation and decision-making skills.

Exceptional critical thinking and analytical skills

Experience with symplr, practice management system(s) and SSQ or other reporting systems a plus

Ability to work well under pressure by prioritizing and managing multiple tasks to meet performance expectations and deadlines.

Exceptional customer service skills with superior written and verbal communication skills

Knowledge of technology, network infrastructure, and interface requirements associated with software integrations a plus

Maintain a professional, businesslike image to clients, visitors, internal staff and the public

Possess a positive attitude and a willingness to learn

Self-motivated and team-oriented

Currently eligible to work in the USA without an employment visa, except for those with a TN visa

Your Future Working Environment

If you join Cedar Gate, you can make great ideas happen for some of the world's most dynamic companies. With broad global resources and deep technical know-how, we collaborate with clients to cultivate ideas and deliver results in the medical industry. Choose a career at Cedar Gate and enjoy an innovative environment where challenging and interesting work is part of daily life.

Next to our excellent terms of employment and fringe benefits, we invest considerable resources to provide ongoing training that builds and extends professional, technical, and management skills in all areas. At Cedar Gate, you will operate in a professional environment where teamwork and innovation are immensely encouraged. Together with colleagues, you will work on high-impact projects for many dynamic companies.

About Cedar Gate

Cedar Gate enables payers, providers, employers, and service administrators to excel at value-based care. Our unified technology and services platform enhances and automates data management activities to deliver employer and provider analytics, care management, and payment technology necessary to pursue every payment model and optimize performance in all lines of business. From primary care attribution to bundled payments to capitation, our platform is designed to improve clinical, financial, and operational outcomes for all.

Based in Greenwich, CT, Cedar Gate is private equity backed by GTCR, a leading Chicago-based private equity firm, Ascension Ventures, a strategic healthcare venture firm, and Cobalt Ventures, the investment subsidiary of BCBS of Kansas City. To learn more, visit