Managed Care Specialist

The Contract Specialist is accountable for the administrative functions of the Managed Care Department including but not limited to coordinating the payor enrollment process with the credentialing team, proactively engaging payors to ensure accurate and timely contract and rate terms loading into the payors claim payment systems and conducting internal education to ensure thorough understanding of key contract terms, working prioritized contract issues within specified timeframes, coordinating agenda and preparing actionable content for effective decision making at Joint Operating Committees with payors, and ensuring all contract documents and fee schedules are maintained for easy reference. This role is important for the successful administration of BrightView’s payor contracts and enables more efficient billing, collections and contract management.

• Ensures contracts are loaded into contract management database/systems accurately and within specified timeframes.
• Ensures the most complete and accurate reports are maintained and shared with the internal departments within BrightView.
• Proactively coordinates with Payor Contracting and Credentialing to ensure timing of contract effective date, credentialing and enrollment efforts are aligned.
• Proactively engages with the payor to ensure timely and accurate in-network participation status, and rate load with respective payors.
• Apply standardized folder and file naming convention to store duly executed contract documents, fee schedules, correspondence in a centralized repository.
• Maintains internal system to ensure contractual correspondence is received timely, and as appropriate, responded to promptly, e.g. amendment notices, audit requests, material change notifications.
• Keys any remaining demographic or contract information into established contract management system, to ensure contract tracker and renewal dates are maintained.
• Coordinates all internal contract and amendment implementation within required BrightView systems.   
• Proactively monitors and confirms with the payor and RCM that expected escalators are realized.
• Proactively researches contract, provider manual, and websites and engages payor contacts to help resolve contract, enrollment, and system load related issues.
• Leads and identifies contract related issues internally and to Joint Operating Committee, prepares actionable content, and coordinates relevant stakeholders for effective decision making.
• Takes a consistent approach to educate internal stakeholders on new contract terms, such as authorization and timely filing requirements, included/excluded services, incentive programs.
• Seeks to establish key contacts within each payor to help solve problems and work issues.
• Assists in understanding new state/market requirements and updates processes accordingly to support new requirements.  Summarizes requirements in established format for reference and distribution to internal stakeholders.
• Coordinates a standardized approach to ensure internal stakeholders understand new contract terms, amendments, and any unique contractual requirements.
• Facilitates consistent approach to Joint Operating Committees, ensuring materials are proactively distributed, agenda is aligned with the payor, key decision makers are present, and progress is achieved.
• Demonstrates continuous improvement. 

Competency, Skills and Abilities:

• HS Diploma required
• Ability to proactively address potential issues and ability to make decisions
• Analytical and problem-solving skills with attention to detail
• Exceptional communication and interpersonal skills
• Collaborative working style and team-player attitude
• Outstanding organizational skills and ability to prioritize tasks
• Able to thrive in a high-volume, deadline-driven work environment
• Excellent computer skills, including experience with Microsoft Office Suite
• Ability to prioritize and manage multiple tasks