Contract Specialist, Managed Care

About the role

The Contract Specialist is responsible for implementing and maintaining nimble’s managed care contracting strategy in a multi-state environment.

Responsibilities

• 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

Qualifications

Participate in departmental training and staff meetings

Adhere to all compliance and company policies and procedures