CareCentrix

• 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.

• Communicate clearly and professionally with team members at all levels, offering thoughtful, constructive feedback when needed. • Support Provider Experience initiatives by tracking project deliverables and helping ensure work is completed on schedule. • Represent the Provider and Service Operations team on companywide and cross-functional projects as assigned. • Maintain accurate, organized documentation to support transparency and accountability across projects. • Assist the Planning and Support team by reviewing project plans, completing assigned tasks, monitoring key metrics, and helping resolve day-to-day issues. • Help develop presentations and materials for leadership and project teams. • Participate in implementation activities and share updates on project progress. • Support the creation and maintenance of project plans to help drive successful outcomes. • Collaborate closely with your team and with cross-functional partners to keep work moving smoothly. • Help create and distribute external provider communications following established policies. • Serve as a positive ambassador for new processes and procedures adopted within the Planning and Support team. • Contribute to special projects and take on additional duties as needed.

• Serve as the initial point of contact for patients seeking home healthcare services • Manage a wide variety of inbound calls from quick, straightforward questions to more complex service requests • Utilize multiple applications and a dual monitor setup to ensure that patients receive the care, supplies, equipment, and support they need • Check the status of service requests • Submit initial requests for items like wheelchairs, wound care, diabetic supplies, etc. • Work an 8-hour shift with a scheduled 30-minute lunch break and scheduled breaks throughout the day

• Monitor and analyze federal and state laws and guidance affecting CareCentrix’s workers’ compensation, auto, and commercial program operations. • Prepare and distribute clear written and verbal communications to impacted business areas. • Provide cross‑functional support, guidance, and direction in developing policies, procedures, and operational changes required for legal and regulatory compliance. • Partner with operational teams to implement these changes effectively. • Secure and maintain all required operational licenses. • Support the onboarding and implementation of new CareCentrix workers’ compensation, auto, and commercial program clients. • Identify and drive continuous improvement initiatives to enhance compliance tracking, trending, and reporting capabilities. • Conduct internal audits as needed and identify opportunities for process improvement. • Develop and deliver training programs to ensure teams fully understand compliance requirements.

• Monitor and analyze federal and state laws and guidance impacting CareCentrix’s government programs • Provide cross-functional guidance in developing policies, procedures, and operational changes • Coordinate and support compliance audits • Assist with onboarding new government program customers • Drive continuous improvement initiatives • Conduct internal audits to assess compliance effectiveness • Design and deliver training programs