Contract Specialist, Managed Care

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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nimble solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💸 Finance

💳 Fintech

☁️ SaaS

Finance • Fintech • SaaS

nimble solutions is a company focused on innovative online solutions, offering services related to payment processing, account management, and invoicing. It leverages web-based technologies to provide efficient and user-friendly platforms for managing financial transactions and accounts. The company aims to simplify complex billing and payment processes for businesses.

📋 Description

• The Contract Specialist is responsible for implementing and maintaining nimble’s managed care contracting strategy in a multi-state environment • Manage and maintain accurate files for each pending and executed managed care contract; provide timely network updates to clients • Serve as the external negotiator with payers on behalf of healthcare facilities and individual providers, handling all aspects of outreach, communication, and contracting logistics • Analyze contract terms, reimbursement structures, and financial impact using data models and payer data • Develop clear, actionable recommendations based on your analysis and present findings directly to the provider client • Partner closely with clients to understand their goals and challenges, and tailor negotiation strategies accordingly • Assist in resolving billing or contractual issues with insurance carriers, advocating on the client’s behalf • Evaluate, negotiate, and renegotiate managed care contracts with health plans, hospitals/health systems, IPAs, government programs, and other payers • Load and validate payer contract terms, rates, and fee schedules into client systems with accuracy and consistency • Ensure organized documentation and version control for all contract files and related payer communications • Track and interpret regulatory updates, policy changes, and market trends that may affect client reimbursement • Support additional client projects, including payer escalations, audits, and strategic network decisions

🎯 Requirements

• Strong analytical and critical thinking skills with the ability to interpret complex data and synthesize into client-ready insights • Demonstrated experience negotiating externally with payers or acting as a liaison between payers and providers is highly preferred • Excellent communication and presentation skills — ability to explain data-driven recommendations to non-technical stakeholders • Highly organized and detail-oriented; able to manage multiple priorities and deadlines in a fast-paced environment • Familiarity with managed care contracts, reimbursement methodologies, and payer systems strongly preferred • Proficiency in Excel and financial modeling tools • Bachelor's degree in Healthcare Administration, Business, Finance, or a related field preferred

🏖️ Benefits

• N/A