Contracting Specialist, Managed Care

Hackensack Meridian Health•Iselin, NJ

About The Position

The Contracting Specialist, Managed Care supports initiatives for HMH Physicians, Physician Related Entities, Urgent Care and Facility, Pay for Performance (P4P), and Professional Behavioral Health Services during system and new-entity negotiations. The role works under senior department leadership and follows Hackensack Meridian Health's established rate and language parameters. It addresses operational, financial, and service issues and facilitates contract implementation across key organizational operational areas for assigned payers and HMH entities.

Requirements

Bachelor's degree in Finance or a health-related field.
At least 3 years of experience in hospital, facility, ancillary, or physician-provider contracting and operations.
A well-rounded, comprehensive understanding of managed care contractual language and regulations, including editing and redlining agreements and amendments.
Ability to negotiate HMH-required language parameters with payers.
Ability to work independently with minimal supervision.
Ability to work under pressure, multitask, and meet departmental and organizational timelines.
Excellent analytical and problem-solving skills.
Tact and sensitivity in communicating effectively with internal and external customers.
Excellent written and verbal communication skills.
Proficient computer skills, including Google Suite and/or Microsoft Office platforms.

Responsibilities

Support the Managed Care Team during system and new-entity negotiations under Managed Care Leadership and in accordance with HMH's established rate and language requirements.
Negotiate contractual language and redline associated agreements and amendments in compliance with HMH legal and business requirements for assigned payers.
Work with internal and external partners on credentialing applications and re-credentialing for assigned payers.
Address operational, financial, and service issues and facilitate contractual implementation with key operational areas for assigned payers and HMH entities.
Assist with educating assigned entities about the requirements of managed care agreements and amendments.
Manage assigned projects within departmental and organizational timelines and established parameters.
Procure internal data for assigned projects.
Assist with reviewing and resolving contractual and operational issues with Managed Care companies.
Perform other duties and projects as assigned.
Adhere to HMH Organizational competencies and standards of behavior.