Managed Care Specialist

Louisville, KY - USA

Monthly Salary: Not Disclosed

Posted on: 20 hours ago

Vacancies: 1 Vacancy

Job Summary

Blue & Co. LLC is a top independent accounting and advisory firm. Healthcare is our largest niche with more than 145 experienced professionals dedicated specifically to the industry.

We are currently seeking a talented Managed Care Specialist to provide subject matter expertise and technical assistance on matters related to Managed Care contracts modeling and operational best practices. This position can be located anywhere within our footprint of Indiana Kentucky Michigan or Ohio. This person will work with Blues rapidly growing Healthcare Reimbursement and Revenue Cycle teams to serve healthcare providers with issues related to Managed Care.

Specific Duties

Read and interpret Managed Care contract terms payment logic and hierarchies to assess risks and to determine opportunity areas of focus for healthcare providers.
Interview provider personnel to obtain additional information on insurance carrier relationships and historical reimbursement trends.
Work with clients to articulate issues requiring attention and develop processes and work plans to address identified issues.
Assist clients with the negotiation of contracts identifying and prioritizing clients underlying needs and goals in order to achieve a positive outcome for the client.
Develop and maintain personal relationships with payors and providers that engender cooperation and trust and are conducive to win-win scenarios.
Review test and analyze large utilization data sets from healthcare providers.
Oversee and prepare financial models utilizing various database software systems.
Development of exhibits and narrative reports outlining our analysis & reimbursement impacts.
Daily verbal and written communication with healthcare providers & health plans.
Review insurance contracts applicable state laws and other financial documentation to determine the proper advice back to clients.

Qualifications

2-6 years of Managed Care related experience that includes the review and negotiation of payor contracts.
Understanding of contract language and Managed Care contract modeling.
Basic understanding of the fundamentals of Values-Based Contracting.
Strong analytical skills; exceptional attention to detail and demonstrated ability to prioritize tasks to ensure accuracy and timely completion.
Investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format with internal and external clients.
Strong organization and documentation skills.
Advanced skills in MS Excel Word and various database programs.
Ability to work autonomously and thrive in a fast-paced environment with shifting priorities.
Advanced interpersonal skills including the ability to listen productively to motivate and to persuade. The successful candidate should be comfortable interacting with senior executives both those internal to Blue & Co. and those who are employed by clients and payors.
Successful candidate should be skilled at organizing and leading professional business meetings.
Selected applicant should be proficient at delivering oral presentations.

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Blue & Co. LLC is a top independent accounting and advisory firm. Healthcare is our largest niche with more than 145 experienced professionals dedicated specifically to the industry.We are currently seeking a talented Managed Care Specialist to provide subject matter expertise and technical assistan...