Managed Care Contract Specialist - Direct Hire - Days - Houston, TX - Virtus Healthcare Staffing, LLC

Managed Care Contract Specialist

Location: Houston, TX

Virtus Healthcare Staffing is seeking a detail-oriented and analytical Managed Care Contract Specialist to join our partner hospital in Houston, TX. This crucial role involves meticulous contract management, financial analysis, and collaboration with various stakeholders to optimize hospital reimbursement and ensure compliance.

Key Responsibilities

• Contract Management: Accurately load, test, and maintain hospital contracts within the contract modeling system. This directly impacts financial adjustments and accounts receivable.
• Financial Analysis: Conduct prospective modeling of proposed contracts, rate structures, and other variables influencing reimbursement, providing critical insights for payer negotiations and daily operations. Analyze the financial impact of government and commercial fee schedule changes.
• Data Management & Reporting: Maintain and update hospital contract reimbursement terms in an internal database. Generate standard and ad-hoc reports to support decision-making regarding hospital reimbursement.
• Collaboration: Work closely with Managed Care Contract Administrators to identify opportunities, risks, and potential errors in payer reimbursement proposals. Serve as a Subject Matter Expert (SME) on facility and professional contract reimbursements.
• Problem Resolution: Collaborate with Revenue Cycle, Finance, Government Reporting, and other teams to resolve contract variances and discrepancies. Participate in third-party payer contract reimbursement projects.
• Vendor Management: Partner with external vendors on contract audit activities and other reimbursement-related matters.
• Process Improvement: Proactively identify and initiate process improvement projects to enhance internal operations and efficiency.
• Compliance & Safety: Uphold organizational policies and procedures, ensuring a safe environment for patients, staff, and visitors. Manage time, supplies, productivity, and service quality within budgetary constraints.
• Professional Development: Engage in mandatory and continuing education activities to promote personal and team growth.

Qualifications:

• Education: Bachelor's degree in Business Administration, Finance, or Accounting is preferred.
• Experience: At least three (3) years of experience in hospital contract modeling, with preference given to candidates with Payment Integrity Compass (PIC) or Epic experience.
• Certifications: Must complete training and certification in relevant EPIC applications within the first 90 days, including Resolute Hospital Billing Expected Reimbursement Contracts Administration.
• Skills:
  • Strong written and oral communication skills.
  • Advanced analytical, problem-solving, and critical thinking capabilities.
  • Exceptional organizational skills, with the ability to work both independently and collaboratively.
  • Proficiency in Excel, including pivot tables and VLOOKUP functions.

Benefits:

• Competitive salary
• Comprehensive health benefits (medical, dental, vision)
• 401(k) with employer match
• Generous PTO
• Equity Options
• Work-from-home flexibility

To Apply:

If you're a detail-oriented and analytical professional with a strong background in hospital contract modeling and payer negotiations, we encourage you to apply today. JoinVirtus Healthcare Staffing and make a valuable contribution to our partner hospital's financial success!