Manager of Managed Care Operations

Department Highlights

• Highly engaged culture.
• Collaborative team environment.
• Fast-paced and Growth-Oriented.

Here Is What You Will Need

• 3+ years of experience in Managed Care, Revenue Cycle Management, or Payer Contracting.
• Demonstrated experience supporting contract implementation or payer enrollment processes.
• Bachelor’s degree in healthcare administration, Business Administration, Finance, or a related field required; equivalent combination of education and relevant experience will be considered.
• Working knowledge of payer enrollment workflows, credentialing, billing system configuration, and claim adjudication processes.
• Ability to interpret contract language and translate financial terms into operational requirements.
• Proficiency in Excel and data management; experience working with healthcare systems (EMR, PM, billing platforms).
• Strong project management skills with the ability to manage multiple concurrent initiatives.
• Exceptional organizational skills and attention to detail.
• Independent problem-solving with appropriate escalation judgment.
• Ability to influence without authority across cross-functional teams.

A Day in the Life of a Manager of Managed Care Operations

• Program & Project Management:
• Develop and maintain a centralized Managed Care Master Project Tracker covering contract negotiations, renewals, expansions, compliance deadlines (e.g., MIPS), and recurring reporting obligations.
• Establish clear timelines, ownership, and accountability across departments.
• Proactively identify bottlenecks and escalate risks that could delay operational readiness or revenue realization.
• Drive projects to completion with measurable outcomes.
• Contract Lifecycle Management:
• Own the administrative transition of negotiated agreements into operational execution.
• Translate contract rates, terms, carve-outs, and provisions into actionable build instructions for Revenue Cycle and system teams.
• Ensure contract terms are accurately reflected in billing systems, payer setups, and reimbursement logic.
• Confirm readiness prior to go-live and monitor initial claims performance post-implementation.
• Payer Enrollment & Network Expansion:
• Coordinate addition of new locations, Tax Identification Numbers (TINs), and providers to existing payer agreements.
• Manage ownership letters, roster submissions, and payer documentation for both commercial and government plans.
• Track and confirm payer approvals and effective dates to prevent reimbursement disruption.
• Maintain accurate provider and location alignment across all payer contracts.
• Cross-Functional Liaison & Implementation Leadership:
• Serve as the primary operational liaison between Managed Care, Legal, Revenue Cycle, Credentialing, Clinical Leadership, and IT.
• Ensure new agreements are fully operationalized across systems (EMR, practice management, clearinghouse, billing platforms).
• Lead internal communication of contract changes and implications.
• Facilitate resolution of implementation gaps that impact revenue or patient access.
• Payer Plan Build & Data Integrity:
• Extract and translate contract data into structured rate tables and build documentation.
• Coordinate creation and maintenance of insurance plans (“iplans”) within applicable technologies.
• Ensure alignment between negotiated terms, system configuration, and billing outputs.
• Maintain a master database of payer contracts, rate structures, and effective dates.
• Issue Resolution & Performance Support:
• Triage and research managed care inquiries, including in/out-of-network status, excluded products, and reimbursement discrepancies.
• Investigate patient leakage and payer denials related to contract misalignment.
• Escalate systemic issues impacting reimbursement or network status.
• Support reporting and closeout activities, including MIPS and charity reporting coordination.

Why Solis Mammography?

• A Great Place to Work, earning this prestigious award for multiple years running.
• Offer competitive benefits such as Medical, Dental, Vision, 401k, PTO, Paid Holidays, Backup Child/Adult Care as well as other unique benefits.