Managed Care Contracting, Performance Advisor

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $113k - $188k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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Guidehouse

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2018

🏥 Healthcare

🎖️ Defense

📦 Logistics

💰 Grant on 2023-02

Healthcare • Defense • Logistics

Guidehouse is a global consultancy offering advisory, digital, and managed services across commercial and public sectors. It is purpose-built to support industries such as national security, financial services, healthcare, energy, and infrastructure. Guidehouse collaborates with leaders to navigate complexity and drives transformational changes that impact the future. Their expertise spans data analytics, digital technologies, risk management, and more, with a strong emphasis on sustainability and innovation.

📋 Description

• Strategically manage, evaluate, negotiate, implement, and monitor managed care contracts • Review and audit existing contracts to identify reimbursement improvement, optimization, and renegotiation opportunities • Perform financial modeling and reimbursement analyses for rate changes, amendments, and new payer arrangements • Evaluate contract language, reimbursement methodologies, payment policies, authorization requirements, carve-outs, and contractual obligations • Develop business cases and executive-level recommendations for contract strategy decisions • Develop and execute negotiation plans for commercial, Medicare Advantage, Managed Medicaid, and other payers • Analyze payer proposals and prepare data-supported counterproposals • Maintain payer communications and relationships to resolve negotiation issues and facilitate contract execution • Coordinate implementation of new or amended managed care agreements • Collaborate with Finance, Revenue Cycle, Patient Access, Case Management, Physician Services, Operations, and payer organizations • Develop contract summaries, reimbursement guides, and operational reference materials • Support payer configuration, billing implementation, reimbursement validation, and operational education • Resolve contract interpretation and post-implementation issues • Establish and monitor KPIs for reimbursement accuracy, denial trends, payment timeliness, underpayments, and revenue yield • Investigate, escalate, and help resolve underpayment, denial, and reimbursement disputes • Analyze payer performance and identify revenue recovery and compliance improvements • Prepare executive reports and presentations on contract performance, negotiation progress, financial impact, and recommendations • Identify and evaluate new payer, IPA, medical group, and physician contracting opportunities • Support physician network and medical group contracting strategies • Assist with value-based care, risk-based contracting, and alternative payment model initiatives • Contribute to managed care strategies supporting organizational growth, financial sustainability, and market expansion

🎯 Requirements

• Bachelor's degree and a minimum 6-8+ years of prior relevant experience, or an AA degree and 8-10+ years of prior relevant experience • Relevant experience may be substituted for formal education or advanced degree • Relevant experience in a healthcare provider, central business office environment, managed care, contracting, healthcare finance, payer relations, related healthcare administrative roles, or revenue cycle outsourcing company • Demonstrated experience negotiating managed care agreements with commercial and government-sponsored health plans • Experience performing reimbursement analyses, financial modeling, and contract reviews • Knowledge of hospital and physician reimbursement methodologies, including Medicare, Medicaid/Medi-Cal, DRG, APC, fee schedules, capitation, and value-based payment models • Strong understanding of managed care contract language and reimbursement structures • Advanced analytical and financial modeling skills • Ability to interpret complex contractual and reimbursement provisions • Negotiation, communication, and relationship-management skills • Ability to work effectively across multiple departments and levels of the organization • Strong project management and organizational skills • Proficiency in Microsoft Excel, PowerPoint, and healthcare financial analytics tools • Up to 10% travel • No clearance required

🏖️ Benefits

• Competitive compensation • Flexible benefits package • Medical, Rx, Dental & Vision Insurance • Personal and Family Sick Time & Company Paid Holidays • Position may be eligible for a discretionary variable incentive bonus • Parental Leave • 401(k) Retirement Plan • Basic Life & Supplemental Life • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts • Short-Term & Long-Term Disability • Tuition Reimbursement, Personal Development & Learning Opportunities • Skills Development & Certifications • Employee Referral Program • Corporate Sponsored Events & Community Outreach • Emergency Back-Up Childcare Program