MCO Contracting Specialist

About the role

The Managed Care Contracting Specialist will contribute to the organization's efforts in negotiating and supporting new and existing Managed Care agreements, ensuring accurate data entry, and maintaining strong relationships with payers.

Responsibilities

• Negotiate and support new and existing Managed Care agreements, including strategy development, contract language review and redlining, pricing, and operational components across current markets, expansions, and market realignment initiatives
• Full life-cycle contract management, including development, review, execution, and post-implementation monitoring
• Serve as a key liaison between the organization and payers for contract negotiations, operational issues, and compliance, maintaining strong relationships and effective communication
• Represent the organization in establishing and maintaining business relationships with payers, providers, and other stakeholders
• Technical support in developing, organizing, processing, and executing contracts; facilitate approval processes from pre-contract through post-signature phases
• Maintain knowledge of payer policies, reimbursement methodologies (fee-for-service, case rates, and infertility-specific bundled/S-Code arrangements), and applicable federal, state, and local regulations
• Review, interpret, analyze, and negotiate contract terms; resolve contractual and operational issues in alignment with organizational and regulatory requirements
• Maintain reporting on contract status, negotiations, and key initiatives
• Support market expansion and new practice integrations by assessing payer coverage, identifying gaps, and providing participation recommendations
• Coordinate and communicate contract terms, medical policy updates, and billing requirements to relevant departments to support accurate execution
• Assist in resolving payer-related and operational issues, including billing, claims, authorization, credentialing, and noncompliance concerns
• Support strategic initiatives and align contracting activities with organizational business goals
• Participate in internal and external meetings; represent Managed Care in discussions related to contracting and operations
• Respond to payer, provider, and internal inquiries, providing timely and effective issue resolution

Requirements

• Bachelor’s degree with 3 to 5 years of relevant experience, or associate degree / equivalent experience with 5–8 years of relevant experience
• 2 to 5 years of experience in contract negotiations and contract modeling
• Strong data analytics skills, including advanced proficiency in Excel; experience with NextGen, Power BI, and Rivet is a plus
• Working knowledge of credentialing and revenue cycle operations as they relate to Managed Care
• Excellent interpersonal skills with the ability to build relationships across a multi-disciplinary team
• Self-starter with the ability to take initiative, work independently, and drive results
• Strong attention to detail with the ability to manage multiple priorities and meet tight deadlines
• Positive, customer-centric mindset with a proactive approach to problem-solving and achieving organizational goals
• Ability to prioritize, multi-task, and adapt in a fast-paced environment
• Experience with infertility contracting (Preferred)

Skills

• Technical skill in contract negotiations and contract modeling
• Data analytics skills, including proficiency in Excel
• Strong communication skills with the ability to convey information clearly and concisely in a remote, cross-functional environment
• Interpersonal skills with the ability to build relationships across a multi-disciplinary team
• Attention to detail with the ability to manage multiple priorities and meet tight deadlines
• Proactive approach to problem-solving and achieving organizational goals
• Ability to prioritize, multi-task, and adapt in a fast-paced environment
• Experience with infertility contracting (Preferred)

Benefits

• Medical, dental, and vision insurance
• 401(k) with company match
• Tuition assistance and professional development support
• Performance-based bonus opportunities
• Generous paid time off, paid holidays, and paid parental leave
• Life and disability benefits
• Fertility Discount Program
• Employee wellness and recognition programs

Pay

$XX.XX - $XXXX per year

Schedule

Monday through Friday, 8:00 AM to 5:00 PM