Managed Care Contracting Representative

Job Summary:

• The Managed Care Contracting Representative analyzes and negotiates contractual language; negotiates reimbursement with managed care plans; communicates with payers and clients regarding managed care negotiations and managed care strategy; provides regular feedback to MGA Executive leadership and Client Services team regarding contracting status.  Maintains contract files and contract systems

Essential Functions and Tasks:

• Develops contracting strategy, determines marketplace position, plan participation, and contract requirements
• Negotiates managed care contracts including case rate, fee-for-service reimbursements, and contractual language, and follow-up with payors and clients throughout the contracting process.
• Analyzes contract proposals for financial impact
• Participates in presenting managed care strategy to clients, faculty, and administration; may be required to educate client’s faculty on determined strategy to obtain buy-in and support.
• Reviews existing agreements and assesses appropriate action for renegotiation, termination, etc
• Manages entire contracting process for assigned contracts and/or clients
• Loads contract terms into Contract Maintenance program, maintains paper & electronic contract files, and maintains any other contract matrix documents used by department
• Negotiates reimbursements providers will receive on behalf of the insurance company; contract language related to MIPS incentive program, Value Based reimbursements, timely submission of claims and payments, claims bundling; and facilitates discussions between clients and providers
• Monitors contract performance compliance and adherence to contract; Current Procedural Terminology (CPT) conversion; place of service
• Performs special projects and other duties as assigned

Education and Experience Requirements:

• High School Diploma or GED
• Bachelor’s Degree in Healthcare Management, Business, or related field preferred, or equivalent training and/or experience
• At least two (2) years of customer service or financial analyst experience working with managed care in a medical or insurance setting

Knowledge, Skills, and Abilities:

• Knowledge of State, Federal, and Managed Care regulatory guidelines
• Knowledge of benefit insurance billing contract management
• Strong oral, written, and interpersonal communication skills
• Strong word processing, spreadsheet, database, and presentation software skills
• Strong mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages; and working with decimals
• Strong decision-making skills
• Strong negotiation skills
• Ability to read, understand, and apply state/federal laws, regulations, and policies
• Ability to persuade and influence
• Ability to exercise sound judgment
• Ability to handle highly sensitive and confidential information appropriately
• Ability to initiate and maintain professional relationships