Out-of-Network Contract Liaison

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $75k - $85k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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MedPOINT Management

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1988

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

MedPOINT Management is a California-based healthcare management services organization that supports independent practice associations (IPAs), provider networks, hospitals and contracted health plans with clinical quality, care management, administrative operations and technology solutions. For more than 32 years MPM has provided services including provider network operations, case management, utilization management, claims operations, credentialing, HEDIS/STARs quality measurement and analytics (via Cozeva), call center and financial management, and digital provider portals and resource libraries. The company emphasizes data security and compliance (SOC 2 and HITRUST e1 certifications for its EZ-CAP and Provider Web Portals) and focuses on enabling value-based care, quality improvement, and operational support for providers and payers.

📋 Description

• Facilitate out-of-network (OON) contract negotiations between providers and health plans • Coordinate with the Utilization Management (UM) team to support OON authorization requests and approvals • Communicate with out-of-network providers regarding single-case agreements and reimbursement terms • Track and document OON contract statuses, agreements, and correspondence in internal systems • Collaborate with claims, UM, and network development teams to resolve OON billing and authorization issues • Ensure compliance with state and federal regulations related to OON services and managed care contracting • Prepare and maintain reports on OON activity, trends, and cost containment outcomes

🎯 Requirements

• 2+ years of experience in managed care, utilization management, or healthcare contracting • Familiarity with out-of-network provider negotiations and single-case agreements • Knowledge of IPA, HMO, and managed care operations strongly preferred • Strong understanding of medical terminology, CPT/ICD-10 codes, and authorization processes • Excellent communication and negotiation skills with internal and external stakeholders • Proficiency in healthcare management systems and Microsoft Office Suite • Highly organized, detail-oriented, and able to manage multiple priorities simultaneously • Legally authorized to work in the US

🏖️ Benefits

• 401(k) • 401(k) matching • Bonus based on performance • Company parties • Dental insurance • Employee discounts • Health insurance • Opportunity for advancement • Paid time off • Parental leave • Savings bank • Training & development • Vision insurance • Wellness resources