Managed Care Contract Specialist - Payor Relations

AdventHealth; United States; On-site; USD 63,000 - 117,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

PTO from Day One

403(b) Retirement Plan

Parental Leave

Career Development

Well-being Resources

Mental Health Resources

Pet Benefits

Job summary

AdventHealth is seeking a skilled professional to analyze managed care contracts, negotiate terms with payors, and ensure compliance with regulatory requirements across our health system. The role collaborates with clinicians and administrative staff to optimize reimbursements and maintain accurate contract records.

The ideal candidate holds a Bachelor's degree, 3+ years in managed care, and a strong understanding of payer operations and contracting practices.

Qualifications

• General knowledge of healthcare, hospital and provider operations, and managed care payer contracts and operations.
• Required: High understanding of managed care payers and contracting requirements.
• Required: Knowledge of healthcare and payer operations.
• Required: Bachelor's degree or equivalent from a four-year college or university.
• Work Experience: 3+ years in managed care or related role.
• Preferred: 5+ years in related role.

Responsibilities

• Analyzes managed care contracts to ensure compliance with organizational standards and regulatory requirements.
• Negotiates contract terms with payors to secure favorable reimbursement rates and conditions.
• Reviews and updates fee schedules and contract modifications to reflect current rates and terms.
• Communicates contract changes and updates to relevant internal departments and stakeholders.
• Collaborates with clinical and support staff to optimize reimbursement and reduce operational overhead.
• Monitors payor compliance with contractual obligations and addresses any discrepancies.
• Maintains accurate and up-to-date records of all managed care contracts and related documentation.
• Provides training and support to staff on managed care contract requirements and changes.
• Facilitates open communication and joint decision-making with payors and internal teams.
• Builds and maintains relationships with payors to ensure effective contract management.
• Resolves any issues or conflicts related to managed care contracts in a timely manner.
• Participates in performance improvement initiatives related to managed care processes.
• Other duties as assigned.

Skills

Managed care contracts

Regulatory compliance

Negotiation

Contract administration

Education

Bachelor's degree

Job description

AdventHealth is seeking a skilled professional to analyze managed care contracts, negotiate terms with payors, and ensure compliance with regulatory requirements across our health system. The role collaborates with clinicians and administrative staff to optimize reimbursements and maintain accurate contract records.

The ideal candidate holds a Bachelor's degree, 3+ years in managed care, and a strong understanding of payer operations and contracting practices.