Managed Care Negotiator

Position Details

Location: Remote must reside in Florida
Status: Full Time (non-exempt)
Shift: 8:00 AM - 5:00 PM (may vary)

Benefits

• Benefits (Health, Dental, Vision)
• Paid time off
• Tuition reimbursement
• 401k match and additional yearly contribution
• Yearly performance appraisals and team award bonus
• Community discounts and more

Responsibilities

• Negotiates agreements under supervision from manager and/or director.
• Sets up managed care negotiations by drafting contract language, preparing internal stakeholder presentations, and assisting with re-negotiations under guidance.
• Evaluates and leads small health plan entrant proposal reviews for inclusion in BayCare's network.
• Performs basic financial analysis to support rate proposals, collaborates with analysts to verify assumptions, and prepares counter proposals.
• Reviews physician credentialing agreements, identifies compliance issues, and assists in resolving disputes with payors.
• Communicates with payors and internal teams throughout negotiation, implementation, and operational phases, and maintains summaries of contract terms.
• Acts as primary point of contact for assigned payers and is responsible for leading internal and external meetings.
• Maintains current files on managed care companies, including contracts, matrices, and correspondence, and distributes notices of contract changes.
• Aids in developing educational materials and provides credentialing information to payors as needed.
• Under general supervision, evaluates and enforces contract compliance.
• Facilitates issue resolution with internal and external stakeholders.

Requirements

• Required: 1-year legal experience or 2 years of Managed Care, Healthcare, or Insurance/Payor experience