Managed Care Services Representative

Managed Care Services Representative

Join Cedar Gate Technologies, an IQVIA business, as a Managed Care Services Representative! 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 Services Representative, 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.

Roles & Responsibilities

• Serve as a primary liaison between internal teams, providers, and payers to resolve managed care issues, support provider communications, and research claims.
• Support clients, providers, and payers by ensuring timely, effective inquiry resolution.
• Build and maintain strong relationships with providers, payers, and internal stakeholders to support seamless operations.
• Collaborate with team members to manage and support Center of Excellence programs, including member education, helpline operations, enrollment, and reporting.
• Research managed care trends and benchmarks and provide analysis and recommendations.
• Prepare data, insights, and summaries to support negotiations with payers, employers, and providers; present findings to senior leadership.
• Assist with the review of payer and provider agreements and support negotiation strategy development.
• Prepare and present quarterly payer account summaries to departmental leadership.
• Collaborate with department leadership to prepare accurate and compliant documentation for Committee and Board meetings.
• Partner cross-functionally to ensure accurate contract, provider, and workflow information and to support client onboarding.
• Track contract status, including expirations, amendments, and notice requirements, and proactively communicate required actions.
• Maintain accurate contract and provider data and documentation across systems, monitor payer policy updates, and coordinate execution of agreements with provider offices.

Job Location: Houston, TX

Work Arrangement: Hybrid (3 days in office, 2 days remote)

Experience / Qualifications

• 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 is required, including reporting, managed care contracting, and patient account resolution with a provider or payer.
• Working knowledge of CPT, HCPCS and ICD-10 coding is highly preferred
• Advanced skills with PowerPoint and Excel with knowledge of pivot tables, Power Queries, and complex formulas
• Experience with claims payment resolution
• Superior written and verbal communication skills
• 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, preferably with experience analyzing and interpreting reports for financial trends in the provider contracting arena
• Exceptional customer service skills with a professional, businesslike image to clients, visitors, internal staff, and the public
• Prefer experience with healthcare systems or platforms, such as symplr, practice management systems, SSQ, or other reporting tools
• Experience working in a Cardiology setting, Cardiology terminology and coding is highly preferred
• To be eligible for this position, you must reside in the same country where the job is located.