Managed Care Specialist
About The Position
Blue & Co., LLC is a dynamic, innovative professional services firm that provides accounting and consulting services to growth-oriented, entrepreneurial clients across multiple industries. Healthcare is our largest industry focus, supported by more than 150 experienced professionals dedicated to serving the sector. We are seeking a Managed Care Specialist to provide subject matter expertise and technical support related to managed care contracts, reimbursement modeling, and operational best practices. The Specialist will work with Blue’s growing Healthcare Reimbursement and Revenue Cycle teams to help healthcare provider clients address managed care and reimbursement challenges.
Requirements
- Two to six years of managed care experience, including review and negotiation of payer contracts.
- Working knowledge of managed care contract language, payment methodologies, and contract modeling.
- Basic understanding of value-based contracting principles.
- Strong analytical skills, attention to detail, and ability to prioritize work to ensure accurate and timely completion.
- Strong investigative, written, and verbal communication skills, with the ability to communicate effectively with internal and external stakeholders.
- Excellent organizational and documentation skills.
- Advanced proficiency in Microsoft Excel and Word; experience with database or analytics tools is preferred.
- Ability to work independently and thrive in a fast-paced environment with changing priorities.
- Strong interpersonal skills, including the ability to listen, influence, and build credibility with senior leaders, clients, providers, and payers.
- Ability to organize and lead professional business meetings and deliver oral presentations.
Nice To Haves
- Strong experience with contract modeling highly preferred.
Responsibilities
- Interpret managed care contract terms, payment methodologies, and reimbursement hierarchies to identify risks and opportunities for healthcare provider clients.
- Interview provider personnel to gather information on payer relationships, contract performance, and historical reimbursement trends.
- Work with clients to define issues, develop practical work plans, and support implementation of recommended solutions.
- Support managed care contract negotiations by identifying and prioritizing client needs and goals to help achieve favorable outcomes.
- Build and maintain productive relationships with payers and providers that promote collaboration and trust.
- Review, test, and analyze utilization and reimbursement data sets from healthcare providers.
- Develop and maintain financial and reimbursement models using database and spreadsheet tools.
- Prepare exhibits, analyses, and narrative reports that clearly communicate findings and reimbursement impacts.
- Communicate regularly, verbally and in writing, with healthcare providers, health plans, and internal project teams.
- Review insurance contracts, applicable state requirements, and financial documentation to support client recommendations.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
