Cedar Gate Technologies Inc-posted 13 days ago
Full-time • Mid Level
Hybrid • Houston, TX
501-1,000 employees

Join Cedar Gate Technologies as a Managed Care Specialist! We’re looking for a dynamic new employee to help shape and manage our provider, payer, and facility contracts. In this role, you’ll develop, negotiate, implement, monitor, and optimize managed care agreements that support our growth and quality of care. You’ll stay on top of industry trends, communicate contract changes across the organization, and analyze performance data to ensure agreements deliver the expected results. As a Managed Care Specialist, you’ll also collaborate closely with internal teams, clients, payers, and providers, building strong relationships and preparing presentations – with the chance to lead or co-present on key initiatives.

  • Act as a key liaison between internal teams, providers, and payers — resolving managed care issues, assisting with provider communications, and researching claims to maintain strong relationships.
  • Support clients, providers, and payers with a focus on timely and effective inquiry resolution.
  • Build and nurture positive relationships with providers, payers, and internal stakeholders to support seamless operations.
  • Research managed care trends and benchmarks to provide analysis and recommendations.
  • Prepare data and insights to support negotiations with payers, employers, and providers; present findings to senior leadership.
  • Coordinate and prepare all documentation for the Contract Committee and Board, ensuring accuracy and compliance.
  • Assist with the review of payer and provider agreements and help develop negotiation strategies.
  • Prepare and present quarterly payer account summaries to departmental leadership.
  • Partner with other departments to ensure smooth workflows and accurate contract and provider information.
  • Support client onboarding by managing payer and provider contract details.
  • Track agreement statuses (expirations, changes, notices) and proactively alert management to required actions.
  • Maintain and validate data across systems (including Cactus and other platforms) to ensure accuracy and completeness.
  • Monitor payer updates in policies and procedures and distributing pertinent information to the appropriate teams in a timely manner.
  • Create, organize, and maintain provider and payer contracting documents in both electronic and paper formats.
  • Coordinate with provider offices to secure the timely completion of documents and distribute executed agreements properly.
  • Contribute to Center of Excellence programs, including member education, helpline support, enrollment, and reporting.
  • Maintain organized systems, filing structures, and resources to support department efficiency.
  • Assist with special projects and additional tasks as assigned.
  • BS/BA in healthcare administration, business, finance, or related field; relevant work experience may be considered
  • 3 or more years of experience in healthcare contracting or business operations, including reporting, managed care contracting, and patient account resolution with a provider or payer.
  • Experience with claims payment resolution
  • Strong Microsoft Office skills, including PowerPoint and Advanced Excel skills with knowledge of pivot tables, Power Queries, and complex formulas
  • Superior written and verbal communication skills
  • Possess a positive attitude and a willingness to learn
  • Ability to work well under pressure by efficiently prioritizing and managing multiple tasks to meet performance expectations and deadlines
  • Strong critical thinking and analytical skills
  • Experience in analyzing and interpreting reports for financial trends in the provider contracting arena
  • Self-motivated and team-oriented
  • Great experience working with CPT and ICD-10 codes
  • Exceptional customer service skills with a professional, businesslike image to clients, visitors, internal staff, and the public
  • Currently eligible to work in the U.S. without any assistance in getting a U.S. employment visa or work authorization.
  • Experience with Cactus, practice management system(s), and SSQ or other reporting systems
  • Cardiology specialization experience
  • comprehensive medical, dental, and vision coverage
  • FSA/HSA options
  • 4% 401(k) matching
  • tuition assistance
  • generous paid time off
  • exclusive employee discounts
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