MCO Contracting Specialist

About the role

The Managed Care Contracting Specialist role is available for a remote position at US Fertility, a leading partnership of physician-led fertility practices. This opportunity offers the chance to grow within a nationally respected organization while staying closely connected to the patients and teams you support.

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
• Perform 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
• Provide 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 data entry of contract terms and specifications into contract management systems and ensure completeness of all contracting processes
• Monitor and track contract performance, including financial outcomes, and support ongoing evaluation of payer reimbursement and fee schedules
• Identify gaps and recommend enhancements to contracts, services, workflows, and operating procedures to improve reimbursement accuracy and operational efficiency
• Collaborate with cross-functional teams, including revenue cycle, credentialing, operations, and leadership, to support contract implementation and ensure compliance
• Coordinate and communicate contract terms, medical policy updates, and billing requirements to relevant departments to support accurate execution
• Absorb and assess payer coverage, identify gaps, and provide participation recommendations for market expansion and new practice integrations
• Build and maintain productive working relationships with internal teams, external partners, vendors, and stakeholders
• 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

Qualifications and Skills

• 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 convey information clearly and concisely in a remote, cross-functional environment
• Strong attention to detail with the ability to manage multiple priorities and meet tight deadlines
• Self-starter with the ability to take initiative, work independently, and drive results
• 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)

What We Offer

• Competitive, comprehensive benefits package
• 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

Our Commitment to Inclusion and Opportunity

US Fertility and its network partners believe that a diverse workforce is essential to fulfilling our mission of expanding patient access to the highest standards of fertility care. We are committed to equitable and inclusive hiring practices that ensure our clinical and operational teams reflect and support the diverse communities and patients we serve.