Blue & Co., LLC
Blue & Co., LLC, is a top independent accounting and advisory firm. Healthcare is our largest niche with more than 145 experienced professionals dedicated specifically to the industry. We are currently seeking a talented Managed Care Specialist to provide subject‑matter expertise and technical assistance on matters related to Managed Care contracts, modeling, and operational best practices. This position can be located anywhere within our footprint of Indiana, Kentucky, Michigan, or Ohio. The role will work with Blue’s Healthcare Reimbursement and Revenue Cycle teams to serve healthcare providers with issues related to Managed Care.
Responsibilities
Read and interpret Managed Care contract terms, payment logic, and hierarchies to assess risks and determine opportunity areas of focus for healthcare providers.
Interview provider personnel to obtain additional information on insurance carrier relationships and historical reimbursement trends.
Work with clients to articulate issues requiring attention and develop processes and work plans to address identified issues.
Assist clients with the negotiation of contracts, identifying and prioritizing clients’ underlying needs and goals in order to achieve a positive outcome.
Develop and maintain personal relationships with payors and providers that engender cooperation and trust, and are conducive to “win‑win” scenarios.
Review, test, and analyze large utilization data sets from healthcare providers.
Oversee and prepare financial models utilizing various database software systems.
Develop exhibits and narrative reports outlining analysis and reimbursement impacts.
Maintain daily verbal and written communication with healthcare providers and health plans.
Review insurance contracts, applicable state laws and other financial documentation to determine the proper advice to clients.
Qualifications
2–6 years of Managed Care related experience that includes the review and negotiation of payor contracts.
Understanding of contract language and Managed Care contract modeling.
Basic understanding of the fundamentals of Values‑Based Contracting.
Strong analytical skills; exceptional attention to detail and demonstrated ability to prioritize tasks to ensure accuracy and timely completion.
Investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format with internal and external clients.
Strong organization and documentation skills.
Advanced skills in MS Excel, Word, and various database programs.
Ability to work autonomously and thrive in a fast‑paced environment with shifting priorities.
Advanced interpersonal skills, including the ability to listen productively, motivate, and persuade senior executives internally and externally.
Skilled at organizing and leading professional business meetings and delivering oral presentations.
Additional Information
Seniority Level : Mid‑Senior level
Employment Type : Full‑time
Job Function : Health Care Provider
Industry : Accounting
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Responsibilities
Read and interpret Managed Care contract terms, payment logic, and hierarchies to assess risks and determine opportunity areas of focus for healthcare providers.
Interview provider personnel to obtain additional information on insurance carrier relationships and historical reimbursement trends.
Work with clients to articulate issues requiring attention and develop processes and work plans to address identified issues.
Assist clients with the negotiation of contracts, identifying and prioritizing clients’ underlying needs and goals in order to achieve a positive outcome.
Develop and maintain personal relationships with payors and providers that engender cooperation and trust, and are conducive to “win‑win” scenarios.
Review, test, and analyze large utilization data sets from healthcare providers.
Oversee and prepare financial models utilizing various database software systems.
Develop exhibits and narrative reports outlining analysis and reimbursement impacts.
Maintain daily verbal and written communication with healthcare providers and health plans.
Review insurance contracts, applicable state laws and other financial documentation to determine the proper advice to clients.
Qualifications
2–6 years of Managed Care related experience that includes the review and negotiation of payor contracts.
Understanding of contract language and Managed Care contract modeling.
Basic understanding of the fundamentals of Values‑Based Contracting.
Strong analytical skills; exceptional attention to detail and demonstrated ability to prioritize tasks to ensure accuracy and timely completion.
Investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format with internal and external clients.
Strong organization and documentation skills.
Advanced skills in MS Excel, Word, and various database programs.
Ability to work autonomously and thrive in a fast‑paced environment with shifting priorities.
Advanced interpersonal skills, including the ability to listen productively, motivate, and persuade senior executives internally and externally.
Skilled at organizing and leading professional business meetings and delivering oral presentations.
Additional Information
Seniority Level : Mid‑Senior level
Employment Type : Full‑time
Job Function : Health Care Provider
Industry : Accounting
EEOC
#J-18808-Ljbffr