Managed Care Contracting Specialist

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Managed Care Contracting Specialist Summary:

Come join our MGM family! We are growing! Excellent wages and benefits! The Managed Care Contracting Specialist manages and leads the contract negotiations with the Managed Care Organizations (MCOs), including rate and language discussions in accordance with established guidelines and aligned with MGM strategic goals. This position develops and maintains strong relationships with the Managed Care Organizations (MCOs). This position also collaborates with the Skilled Nursing Facilities (SNF) and MGM Home Office team members in order to identify challenges and opportunities for improvement around contract performance.

Managed Care Contracting Specialist Qualifications:

  • Extensive knowledge of contract management, contracting concepts and demonstrated knowledge and ability in connection with contract review and negotiations, contract principles, and interpretation of contract language.
  • knowledge and understanding of HMO, Capitation, POS and PPO contracts
  • Knowledge of state and federal regulations.
  • Excellent written and verbal communication skills
  • Must be proficient in Microsoft Word, Excel, Outlook and PowerPoint.
  • 2+ years’ experience in multi-facility contracting role preferred.
  • Ability to travel approx. 10% of the year.
  • Able to prioritize and organize tasks at hand to meet specific deadlines.
  • Strong attention to detail, positive attitude and a proven ability to lead a team to success.
  • Presentation skills desirable.
  • Able to work with a diverse group of people.
  • Must be able to work in a fast-paced office environment.

Managed Care Contracting Specialist Pay & Benefits:

  • Competitive Pay Based On Experience
  • Paid time off
  • Health insurance
  • Dental insurance
  • 401K 
  • Other types of insurance

Managed Care Contracting Specialist Responsibilities:

  • Collaborates with AR Manager, Revenue Director, Chief Operating Officer, and other executive leaders to develop and manage a centralized and efficient contract review and execution process.
  • Negotiates complex managed care contracts on behalf of the MGM
  • leads contract discussions with managed care organizations, including reviewing and drafting contract language provisions that protect MGM’s revenue and improve administrative functions and negotiating rates.
  • Monitors and maintains efficient contract operations and ensures prompt completion of assigned contracts.
  • Timely follow-ups on contracts for prompt execution.
  • Tracks expiration and termination dates of all contracts; ensures prompt upload into appropriate databases.
  • Develops and submits routine reports and updates to AR Manager, Revenue Director, Chief Operating Officer and other executive leaders of contracting activities.
  • Facilitates problem solving of identified contractual and operational issues in collaboration with managed care organizations and internal MGM stakeholders
  • Identifies and communicates opportunities for process improvement with managed care organizations and MGM stakeholders.
  • Stays knowledgeable of the changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts.
  • Leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision making.
  • Coordinates with the revenue and operations teams to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood.
  • Coordinate that all reimbursement logic is appropriately built in the system
  • Maintains strict compliance with State, Federal and other regulations
  • Adheres to all HIPAA guidelines.
  • COMPLIANCE AND INTEGRITY: Models and reinforces ethical behavior in self and to others in accordance with the Code of Conduct; adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty; shows consistency in words and actions; follows through on commitments.
  • Performs other duties as may be assigned.

For inquiries contact:

MGM Healthcare

477 N. Lindbergh Ste. 310

St. Louis, MO 63141

(314)631-3000

AAP/EEO Statement

MGM Healthcare provides equal employment opportunities. We are committed to complying with all state, federal, and local laws that prohibit discrimination in employment, including recruitment, hiring, placement, promotion, transfers, compensation, benefits, training, programs, reductions in workforce, termination, and recall. Our facility strives to provide equal opportunity for employment to all individuals who are properly qualified and able to perform the duties of their employment, without regard to employees’ legally-protected characteristics (“protected class”) including: age, sex, race, color, creed, religion, national origin, ancestry, citizenship, marital status, pregnancy, medical condition, physical or mental disability, sexual orientation, gender identity, sex stereotyping, or genetic information.