CareCentrix

• Conduct medical necessity reviews for cases that may not meet established criteria and issue adverse determinations when appropriate • Evaluate requests across post-acute care services in alignment with clinical and regulatory standards • Meet or exceed Service Level Agreements (SLA) and performance guarantees required by health plan clients • Apply sound clinical judgment and maintain integrity in all determinations and interactions • Collaborate effectively with internal and external stakeholders, including providers and physicians • Perform other duties as assigned

• Partner with the President and senior leadership team to define, prioritize, and execute company-wide strategic initiatives. • Translate strategic objectives into actionable plans, milestones, deliverables, and governance routines, while owning and maintaining accountability for successful execution and delivery. • Drive cross-functional alignment across departments to ensure priorities are clearly understood, coordinated, and executed effectively. • Identify risks, dependencies, barriers, and opportunities that may impact the delivery of strategic priorities and develop mitigation plans as needed. • Lead and support high-impact initiatives that span multiple business functions and require executive visibility and engagement. • Lead the development and ongoing management of corporate and operational dashboards, delivering accurate, actionable insights to leadership. • Oversee consistent reporting and performance analysis of key indicators across contracting, provider access, operational performance, service metrics, and other priority business areas. • Gather, analyze, and communicate key performance metrics that inform decision-making and business outcomes. • Deliver executive-facing analytics, business reviews, and performance narratives that highlight trends, risks, opportunities, and recommended actions. • Leverage data and insights to proactively identify and recommend opportunities to improve organizational performance and operational effectiveness. • Support annual budgeting and quarterly forecasting processes through performance analytics, business insights, and executive-level reporting. • Partner with leaders to conduct ROI analyses that support prioritization of cost savings, efficiency initiatives, and operational improvements. • Provide visibility into costs, ROI, resource allocation, and progress against budget and strategic objectives. • Identify opportunities to improve technology, reporting capabilities, and business processes that enhance operational efficiency and organizational effectiveness. • Champion a culture of continuous improvement by identifying inefficiencies and implementing practical solutions that streamline operations and improve quality outcomes. • Manage executive priorities, leadership meeting cadences, follow-up actions, and preparation of materials for key leadership discussions. • Oversee enterprise-wide communication and meeting support for the President, including town halls, senior leadership meetings, and organizational announcements. • Ensure clear and consistent communication of priorities, decisions, progress, and expectations across leadership teams and the broader organization. • Build strong, trusted partnerships across the organization to foster collaboration, alignment, and effective execution. • Provide strategic and operational support on additional priorities and initiatives as requested by the President. • Lead, coach, and develop a team responsible for enterprise planning, performance reporting, analytics, corporate communications, and executive support for the President and senior leadership team. • Establish clear expectations, priorities, and operating rhythms that drive accountability and high-quality execution. • Foster a collaborative, accountable, and service-oriented culture focused on business impact, continuous improvement, and organizational success.

• Lead the development and execution of enterprise-wide provider network and contacting strategies to ensure network adequacy, competitive positioning, and alignment with business growth objectives • Define and drive multi-year provider contracting roadmaps, including rate strategy, value-based care models, and risk-sharing arrangements • Oversee network design, expansion, and optimization across markets, ensuring alignment to cost-of-care targets, access standards, and product strategy • Utilize market intelligence, competitive insights, and performance analytics to inform network composition and contracting priorities • Ensure network configurations balance cost efficiency, quality outcomes, and provider access including optimization of high performing and preferred provider tiers • Direct end-to-end provider network development, including contracting strategy, negotiation execution, reimbursement methodologies, and ongoing performance management • Establish and implement innovative contracting models (e.g. value-based care, bundled payments, shared savings, capitation where appropriate) to drive cost, quality, and experience outcomes • Lead complex provider negotiations with health systems, specialty providers, and ancillary partners, ensuring alignment with financial targets and strategic priorities • Identify and executive opportunities to strengthen network performance through contract optimization, utilization management alignment, and provider incentives • Oversee network capacity planning, coverage adequacy, and provider mix optimization to meet demand and growth projections • Drive enhancements to provider-facing tools, systems, and processes to improve operational efficiency and experience • Ensure all network initiatives and contracting programs delivery against defined KPIs, including affordability, unit cost reductions, ROI and performance guarantees • Partner with Product, Clinical, and Market leaders to align network capabilities with product design and clinical program requirements • Ensure provider contracts and reimbursement structures support new product features, care models and clinical program requirements • Enable scalable network and contracting solutions to support new market entry, product launches, and client-specific configurations • Lead the development of network-related program capabilities and positioning to support client growth and retention • Partner closely Sales, Underwriting, Medical Economics, and Actuarial teams to align network contracting strategy with pricing, underwriting assumptions and growth targets • Support pre-sale and post-sale activities through network strategy articulation, provider disruption analysis, and competitive positioning • Ensure timely adaptation of network models in response to evolving healthcare landscape and client needs • Serve as a key liaison between Network Management, Product / Network Analytics, Medical Economics, Provider Experience, Clinical Operations, Compliance, Revenue Cycle Management (RCM), Implementations and Operations teams • Align stakeholders around contracting strategies, financial targets, and execution plans, ensuring seamless operationalization • Provide strategic input into enterprise priorities, including cost-of-care management, provider partnerships, and long-term growth strategy • Represent CareCentrix in executive-level negotiations with provider organizations, health systems and strategic partners • Build and maintain strong, collaborative provider relationships that enable favorable contracting outcomes and long-term partnership value

• Develop trusted partnerships with internal and external stakeholders • Support DME Navigator implementation efforts • Collaborate with clients to understand operational needs and priorities • Maintain a working understanding of client business needs • Use performance reports and operational data to monitor account health • Record and maintain organized CRM documentation • Support standard client updates and changes • Participate in client meetings and regular touchpoints • Partner with the Account Management Service Operations team • Manage client requests and escalations

• Own strategic leadership for a focused portfolio of accounts, establishing a multi year vision and success metrics that drive retention, upsell, and growth in alignment with client and company objectives. • Serve as the primary executive advisor for assigned accounts, cultivating trusted, C suite level relationships that support long term retention, expansion, and partnership growth. • Apply client business models, contractual agreements, and financial models to proactively identify strategic risks, growth opportunities, and value creation initiatives. • Create and manage account planning that supports growth, communicates value, and guides renewals, pricing, and expansion. • Leverage advanced financial modeling, performance analytics, and market insights to assess profitability and optimize value for both the client and organization. • Provide strategic governance over account execution, ensuring cross functional teams deliver outcomes aligned with client commitments and contractual agreements. • Act as executive sponsor for client initiatives, guiding scope, priorities, and outcomes while influencing senior leaders across operations, clinical, product, and technology. • Lead high impact negotiations, escalations, and risk mitigation efforts, defining resolution strategies that protect organizational relationships, external partnerships, and long term client trust. • Translate client strategy into organizational internal priorities, aligning leadership teams to coordinated execution and accountability. • Lead and facilitate executive level client JOCs and forums, including strategic planning sessions, governance reviews, and organizational business reviews • Analyze market trends and performance issues to deliver insights that inform client strategy and business decisions. • Manages implementation efforts by coordinating across internal and external stakeholders, tracking deliverables, and escalating risks. • Provides mentorship to Lead and Senior Account Managers by setting best practices, advancing strategic and financial capabilities, and influencing Account Management standards.

• Monitor and analyze federal and state laws and guidance impacting CareCentrix’s government programs (e.g., Medicare Advantage and Managed Medicaid) and communicate updates clearly through written and verbal channels to relevant business areas. • Provide cross-functional guidance in developing policies, procedures, and operational changes to ensure compliance with legal requirements, and support implementation across operational teams. • Coordinate and support compliance audits, including Medicare Part C program audits, reporting, and managed Medicaid audits, ensuring timely and accurate responses. • Assist with onboarding new government program customers, ensuring compliance requirements are integrated into operational processes. • Drive continuous improvement initiatives to enhance compliance tracking, trending, and reporting tools for greater efficiency and accuracy. • Conduct internal audits to assess compliance effectiveness and identify opportunities for improvement. • Design and deliver training programs that promote a clear understanding of compliance requirements across the organization.

Overview We’re seeking a Revenue Cycle Representative, Reconsiderations to join our RCM – Reconsiderations team and help ensure accurate, timely, and successful resolution of denied or underpaid claims through detailed research, follow‑up, and collaboration with payors. As a Revenue Cycle Representative, Reconsiderations you will determine the acceptance of providers' payment through claims research, plans, eligibility and notes to determine if the payor owes payment to CareCentrix. Identifies and escalates provider issues and concerns to the appropriate senior. Works under general supervision. Guides collectors in their performance of invoice processing activities to ensure receivables are reimbursed in an accurate and timely basis. Works directly with the payer, internal and external customers and other contract clients towards efficient and effective collection results. Responsibilities In this role, you will: - Ensure coordination of provider invoice activities to support timely reimbursement, using databases, online tools, and phone outreach. - Research and resolve claim denials that fail payer edits, preparing corrections and appeals through electronic and paper processes. - Verify patient eligibility, benefits, and health‑plan information using payer databases, CareCentrix eligibility systems, and medical documentation. - Monitor and analyze invoice processing and payer responses using Windows‑based systems, Microsoft Excel, Microsoft Access, and other tools to ensure prompt payment. - Support accounts receivable accuracy and process improvements by resolving overpayments, clearing variances, preparing corrected bills, and contributing to workflow enhancements. - Collaborate and build strong relationships with internal and external partners—including providers, physicians, patients, and payer representatives—to obtain documentation, clarify requirements, and ensure successful reimbursement. Qualifications This role could be a great fit if you: - Have a high school diploma or equivalent. - Minimum of two (2) years of experience in medical claims processing and reimbursement within healthcare revenue cycle environment. - Working knowledge of healthcare collections procedures and related internal and external claims processing software applications. - Strong analytical, verbal, and written communication skills, with the ability to interpret payer requirements and resolve complex claim issues. - Knowledge of HIPAA regulations, the Fair Credit and Collections Act, and medical billing and coding standards including HCPCS, CPT, and ICD‑9/ICD‑10. - Familiarity with Utilization Management (UM) processes and URAC standards. - Intermediate proficiency in Microsoft Office applications (Excel, Word, Access preferred) and ability to perform mathematical calculations related to billing, payments, and adjustments. - Highly organized, detail‑oriented, and able to manage multiple priorities with strong time‑management skills in a fast‑paced environment. What We Offer - Pay Range: $18 - $20.00/ hour, plus corporate bonus incentive. This range reflects potential future growth and earning opportunities. - Benefits: Medical, Dental, Vision, 401(k) with company match, HSA employer contributions, Dependent Care FSA employer contribution, Paid Time Off, Personal/Sick Time, Paid Parental Leave, and more. - Award-winning culture: Keeps our company values at the heart of everything we do: We Care; We Do the Right Thing; We Strive for Excellence; We Think BIG; We Take our Work Seriously, Not Ourselves. CareCentrix maintains a drug-free workplace. We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law. Applications are accepted on an ongoing basis until a candidate is selected.

• Lead the direct negotiation of a significant portion of CareCentrix provider contracts across multiple health plans, payers, and product lines (DME, Sleep, Home Infusion, Home Health) to support strategic business goals. • Manage the full lifecycle of contract negotiations and renegotiations, ensuring all documents progress efficiently through to final signature. • Collaborate with key internal stakeholders—including Legal, Revenue Cycle leadership, and Care Service Center teams —to ensure contract terms align with operational requirements. • Ensure all contracts and associated fee schedules are complete, accurate, and submitted in a timely manner. • Facilitate the onboarding process for new providers joining the network. • Identify and coordinate alternative providers to ensure uninterrupted patient care during provider transitions or contract terminations. • Maintain a strong understanding of provider reimbursement methodologies (Home Health, DME, Home Infusion, Sleep) and stay informed on evolving payment models. • Build and strengthen relationships with key provider partners to drive collaboration and performance. • Partner with providers to develop contracting strategies that enhance network coverage with high‑quality, cost‑efficient providers delivering timely service to members.

Overview Contract Managers play a critical role in managing the CareCentrix provider network. They support contracting activities and oversee network providers across multiple payers. In this position, you will prepare, analyze, negotiate, and maintain provider contracts for services delivered on behalf of our clients. You will build and maintain strong relationships with providers and internal partners to ensure a high level of engagement and satisfaction. Additionally, you will help shape and execute the network management strategy, including value‑based care initiatives, market expansion, compliance, and overall provider experience. Responsibilities - Lead the direct negotiation of a significant portion of CareCentrix provider contracts across multiple health plans, payers, and product lines (DME, Sleep, Home Infusion, Home Health) to support strategic business goals. - Manage the full lifecycle of contract negotiations and renegotiations, ensuring all documents progress efficiently through to final signature. - Collaborate with key internal stakeholders—including Legal, Revenue Cycle leadership, and Care Service Center teams —to ensure contract terms align with operational requirements. - Ensure all contracts and associated fee schedules are complete, accurate, and submitted in a timely manner. - Facilitate the onboarding process for new providers joining the network. - Identify and coordinate alternative providers to ensure uninterrupted patient care during provider transitions or contract terminations. - Maintain a strong understanding of provider reimbursement methodologies (Home Health, DME, Home Infusion, Sleep) and stay informed on evolving payment models. - Build and strengthen relationships with key provider partners to drive collaboration and performance. - Partner with providers to develop contracting strategies that enhance network coverage with high‑quality, cost‑efficient providers delivering timely service to members. Qualifications - Bachelor’s degree desired. Equivalent relevant work experience may be considered in lieu of a degree. - Minimum of 4 years of experience in a healthcare organization involving managed care contracting (e.g., provider relations, network development). - Strong ability to interpret financial analyses and translate data into clear written summaries and actionable recommendations. - Experience with bundled payment contracting or risk‑based/capitated payment models is preferred. - Proficient in Microsoft Office, including Excel and PowerPoint, with advanced skills in computer systems, data management, and database development. - Demonstrated success in contract negotiations, meeting facilitation, agenda creation, and achieving defined goals. - Proven ability to meet stretch goals under challenging circumstances. - Skilled in tracking, editing, and managing complex contracts involving multiple language iterations and addenda. - Ability to collaborate effectively across internal teams and departments. What We Offer What We Offer: - Pay Range: $70000 - $80000 / year plus corporate bonus incentive. - Benefits: Medical, Dental, Vision, 401(k) with company match, HSA employer contributions, Dependent Care FSA employer contribution, Paid Time Off, Personal/Sick Time, Paid Parental Leave, and more. - Award winning culture: Keeps our company values at the heart of everything we do: We Care; We Do the Right Thing; We Strive for Excellence; We Think BIG; We Take our Work Seriously, Not Ourselves. #IDCC CareCentrix maintains a drug-free workplace. We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law. CareCentrix accepts applications on an ongoing basis until a candidate is identified.

• Partnering with Product Owner and leadership to execute product strategy aligned with organizational and market demands • Drive solution development to improve patient outcomes • Collaborate cross-functionally with CareCentrix teams to identify integration opportunities • Refining and communicating clear value propositions • Developing strong business cases to support strategic initiatives • Incorporating customer feedback into product enhancements • Lead client implementations and oversee end-to-end product strategy