Managed Care Specialist

Managed Care Specialist

Blue & Co., LLC is a dynamic and innovative professional services firm providing growth-committed entrepreneurial clients with accounting and consulting services across multiple industries. Healthcare is our largest niche with more than 150 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, Ohio, or Texas. This person will work with Blue's rapidly growing Healthcare Reimbursement and Revenue Cycle teams to serve healthcare providers with issues related to Managed Care.

Position Details:

• 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.

Position Requirements:

• 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.

Blue & Co., LLC, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, sex, sexual orientation, gender identity, disability, genetic information, national origin, race, religion, veteran status, or any other protected category.

Candidates must be authorized to work in the U.S. without current or future employer sponsorship

Agency candidates will not be considered for this position