Managed Care Contracting Specialist

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

• The Managed Care Contracting Specialist 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 Success team regarding contracting status.  Maintains contract files and contract systems

• 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

• 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 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

Equal Employment Opportunity (Applicable only in the US)
Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.
 
Recruitment Agencies
Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.
 
Solicitation of Payment
Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention Candidates
Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.
To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/. 

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