Managed Care Contracting Representative

Job Locations US-FL-Jacksonville
ID 2023-2250
Location Status
Position Type
Regular Full-Time


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

Base Compensation:   

  • Base Compensation for this position: $20.00 - $30.00 per hour
  • Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons 
  • This position is also eligible for discretionary performance bonuses in accordance with company policies 



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