Managed Care Specialist

ID 2025-5709
Location/Org Data : Name Linked
Remote Nationwide U.S.A.
Location Status
Remote
Segment
Emergency Segment
Work Shift Time Zone
Eastern Time

About Us

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.

  • Come Join Our Team!
    • As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards.

  • Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus!

Job Summary

Facilitates resolution of contract variances and other contract discrepanciesCommunicates with payers and other departments within the organization regarding managed care projectsProvides regular feedback to Client Services, Posting, and Call Center teams regarding contract variance statusMaintains contract files 

Essential Functions and Tasks

  • Maintains daily, weekly, and monthly reporting requirements assigned to the Managed Care team 

  • Identifies and resolves contract variances, which may include working with other departments internally; working directly with payers; and reviewing contract language/rates. 

  • Loads and manages non-par processes 

  • Answers questions and provides training and managed care related guidance to other departments within our organization 

  • Conducts contract performance reviews on all new and renegotiated contracts to ensure accurate reimbursement.  Analyzes accounts receivable for expected outcomes from renewal and renegotiations 

  • Submits project appeals related to contract performance issues for all specialties 

  • Performs special projects and other duties as assigned 

Education and Experience Requirements

  • High School Diploma or GED 

  • At least three (3) years of experience in medical billing 

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 decision-making skills 

    • Strong problem-solving skills 

    • Strong time management skills 

    • Basic word processing, spreadsheet, database, and presentation software skills 

    • Basic mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages; and working with decimals 

    • Ability to read, understand, and apply state/federal laws, regulations, and policies 

    • Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately 

    • Ability to remain flexible and work within a collaborative and fast paced environment  

    • Ability to communicate with diverse personalities in a tactful, mature, and professional manner 

Compensation

  • 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 a discretionary incentive bonus in accordance with company policies. 

Ventra Health

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/. 

 

Statement of Accessibility
Ventra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.

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