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Contract Specialist, Managed Care
Location
United States
Posted
6 hours ago
Salary
0
Seniority
Senior
Job Description
Contract Specialist, Managed Care
nimble solutions
• The Contract Specialist is responsible for implementing and maintaining nimble’s managed care contracting strategy in a multi-state environment • Manage and maintain accurate files for each pending and executed managed care contract; provide timely network updates to clients • Serve as the external negotiator with payers on behalf of healthcare facilities and individual providers, handling all aspects of outreach, communication, and contracting logistics • Analyze contract terms, reimbursement structures, and financial impact using data models and payer data • Develop clear, actionable recommendations based on your analysis and present findings directly to the provider client • Partner closely with clients to understand their goals and challenges, and tailor negotiation strategies accordingly • Assist in resolving billing or contractual issues with insurance carriers, advocating on the client’s behalf • Evaluate, negotiate, and renegotiate managed care contracts with health plans, hospitals/health systems, IPAs, government programs, and other payers • Load and validate payer contract terms, rates, and fee schedules into client systems with accuracy and consistency • Ensure organized documentation and version control for all contract files and related payer communications • Track and interpret regulatory updates, policy changes, and market trends that may affect client reimbursement • Support additional client projects, including payer escalations, audits, and strategic network decisions
Job Requirements
- Strong analytical and critical thinking skills with the ability to interpret complex data and synthesize into client-ready insights
- Demonstrated experience negotiating externally with payers or acting as a liaison between payers and providers is highly preferred
- Excellent communication and presentation skills — ability to explain data-driven recommendations to non-technical stakeholders
- Highly organized and detail-oriented; able to manage multiple priorities and deadlines in a fast-paced environment
- Familiarity with managed care contracts, reimbursement methodologies, and payer systems strongly preferred
- Proficiency in Excel and financial modeling tools
- Bachelor's degree in Healthcare Administration, Business, Finance, or a related field preferred
Benefits
- N/A
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