Strategic Managed Care & Reimbursement Specialist

Blue & Co., LLC; Richardson (TX); On-site; USD 85,000 - 120,000; Full time

Job summary

Blue & Co., LLC is seeking a Managed Care Specialist to provide subject matter expertise in contracts, reimbursement modeling, and operational best practices for healthcare provider clients. You will work with Blue’s Healthcare Reimbursement and Revenue Cycle teams to address managed care and reimbursement challenges.

You will interpret contract terms, analyze payer data, and develop financial models to support recommendations and client success in a fast-paced environment.

Qualifications

• 2–6 years of managed care experience.
• Experience reviewing/negotiating payer contracts.
• Knowledge of contract language and modeling.
• Advanced Excel and data analysis skills.
• Ability to communicate with senior leaders and clients.
• Strong organization and documentation skills.

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.

Skills

Analytical skills

Strong communication

Attention to detail

Project coordination

Tools

Microsoft Excel

Microsoft Word

Database tools

Job description

Blue & Co., LLC is seeking a Managed Care Specialist to provide subject matter expertise in contracts, reimbursement modeling, and operational best practices for healthcare provider clients. You will work with Blue’s Healthcare Reimbursement and Revenue Cycle teams to address managed care and reimbursement challenges.

You will interpret contract terms, analyze payer data, and develop financial models to support recommendations and client success in a fast-paced environment.