Manager of Managed Care Operations

Manager of Managed Care Operations Looking to elevate your career? Join us! Work Location: Hybrid Work Hours: Full time, business hours Department Highlights: Highly engaged culture. Collaborative team environment Fast-paced and Growth-Oriented Here is what you will need: 3 years of experience in Managed Care, Revenue Cycle Management, or Payer Contracting. Demonstrated experience supporting contract implementation or payer enrollment processes. Bachelor's degree in healthcare administration, Business Administration, Finance, or a related field required; equivalent combination of education and relevant experience will be considered. Working knowledge of payer enrollment workflows, credentialing, billing system configuration, and claim adjudication processes. Ability to interpret contract language and translate financial terms into operational requirements. Proficiency in Excel and data management; experience working with healthcare systems (EMR, PM, billing platforms). Strong project management skills with the ability to manage multiple concurrent initiatives. Exceptional organizational skills and attention to detail. Independent problem-solving with appropriate escalation judgment. Ability to influence without authority across cross-functional teams. A Day in the Life of a Manager of Managed Care Operations: Program & Project Management Develop and maintain a centralized Managed Care Master Project Tracker covering contract negotiations, renewals, expansions, compliance deadlines (e.g., MIPS), and recurring reporting obligations. Establish clear timelines, ownership, and accountability across departments. Proactively identify bottlenecks and elevate risks that could delay operational readiness or revenue realization. Drive projects to completion with measurable outcomes. Contract Lifecycle Management Own the administrative transition of negotiated agreements into operational execution. Translate contract rates, terms, carve-outs, and provisions into actionable build instructions for Revenue Cycle and system teams. Ensure contract terms are accurately reflected in billing systems, payer setups, and reimbursement logic. Confirm readiness prior to go-live and monitor initial claims performance post-implementation. Payer Enrollment & Network Expansion Coordinate addition of new locations, Tax Identification Numbers (TINs), and providers to existing payer agreements. Manage ownership letters, roster submissions, and payer documentation for both commercial and government plans. Track and confirm payer approvals and effective dates to prevent reimbursement disruption. Maintain accurate provider and location alignment across all payer contracts. Cross-Functional Liaison & Implementation Leadership Serve as the primary operational liaison between Managed Care, Legal, Revenue Cycle, Credentialing, Clinical Leadership, and IT. Ensure new agreements are fully operationalized across systems (EMR, practice management, clearinghouse, billing platforms). Lead internal communication of contract changes and implications. Facilitate resolution of implementation gaps that impact revenue or patient access. Payer Plan Build & Data Integrity Extract and translate contract data into structured rate tables and build documentation. Coordinate creation and maintenance of insurance plans ("iplans") within applicable technologies. Ensure alignment between negotiated terms, system configuration, and billing outputs. Maintain a master database of payer contracts, rate structures, and effective dates. Issue Resolution & Performance Support Triage and research managed care inquiries, including in/out-of-network status, excluded products, and reimbursement discrepancies. Investigate patient leakage and payer denials related to contract misalignment. Escalate systemic issues impacting reimbursement or network status. Support reporting and closeout activities, including MIPS and charity reporting coordination. Why Solis Mammography? A Great Place to Work, earning this prestigious award for multiple years running. Offer competitive benefits such as Medical, Dental, Vision, 401k, PTO, Paid Holidays, Backup Child/Adult Care as well as other unique benefits. #J-18808-Ljbffr Comprehensive Breast Care Center Inc. dba Solis