Managed Care Consultant

#LIhybrid

Managed Care Consultant

Thank you for your interest in the Managed Care Consultant position on Blue's rapidly growing Healthcare Reimbursement and Revenue Cycle team to serve healthcare providers with issues related to Managed Care. Before you look at the position description below, we wanted to introduce you to an important philosophy we have at Blue.

We want to meet you where you are in your life.

There are many ways to define success. At Blue, we believe your path to success will look different at different points in your life. We also believe success means different things to different people. That is why we value diverse people and why we work hard to create a unique career path for everyone. We firmly believe when your needs are met, you will be better equipped to meet the needs of our clients. We want to understand your unique needs so we can meet you where you are professionally and personally.

Blue is hiring a Managed Care Consultant to provide subject matter expertise and technical assistance on matters related to Managed Care contracts, modeling, and operational best practices.

Specific Duties

• Read and interpret Managed Care contract terms, payment logic, and hierarchies to assess risks and to determine opportunity areas of focus for healthcare providers.
• Work with providers 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 to achieve a positive outcome for the client.
• Develop and maintain personal relationships with payors and providers that engender cooperation and trust and are conducive to "win-win" scenarios.
• Assist the clients in crafting contract language that is unambiguous, compliant, practical, and acceptable to payors and providers.
• Review, test, and analyze large utilization data sets from healthcare providers.
• Oversee and prepare financial models utilizing various database software systems.
• Development of exhibits and narrative reports outlining our analysis & reimbursement impacts.

Here are the qualifications you should bring to the table:

• Must have a minimum of five years of Managed Care related experience that includes the negotiation of payor contracts and the related financial modeling.
• Strong background in healthcare reimbursement analysis, including an understanding of diagnosis and procedure coding, billing practices, and payment methodologies.
• Understanding of contract language and Managed Care contract modeling.
• In-depth 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.
• Must be able to lead and coordinate projects through various complex and challenging situations to completion under time-sensitive deadlines.
• Ability to work autonomously and thrive in a fast-paced environment with shifting priorities.
• Advanced interpersonal skills, including the ability to listen productively, to motivate, and to persuade.

Blue is proudly ranked as a top 60 CPA firm in the U.S. and named as a "Best Place to Work" in Indiana and Kentucky, and "Best Employer" in Ohio. We take pride in fostering a great culture, providing award-winning professional growth opportunities, and offering the ability to work either in-office, remote or a hybrid combination. At Blue we truly value the development of ALL employees and encourage them to bring their true authentic selves to work.