Managed Care Provider Relations Manager jobs in Pasadena, TX

Overview:

Curitec is seeking a skilled individual to join our team as a Managed Care Provider Relations Specialist. This role is pivotal in managing all aspects of contracting within our managed care operations while also overseeing various related responsibilities such as portal access, reporting, cash posting, enrollments (ERNs and EOBs), and insurance audits. The ideal candidate will bring a comprehensive understanding of contracting processes, exceptional attention to detail, and the ability to effectively navigate the complexities of managed care.

Qualifications:

- Bachelor's degree in business administration, healthcare management, or a related field; relevant certifications preferred.

- Minimum of 3-5 years of experience in managed care contracting, insurance administration, or a related area within the healthcare industry.

- Proven track record of successfully negotiating contracts and managing payer relationships.

- Proficiency in using insurance portals and related software applications.

- Strong organizational skills with the ability to prioritize tasks and manage time effectively.

- Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders.

- Detail-oriented with a high level of accuracy in data entry and record-keeping.

- Ability to adapt to changing priorities and work well under pressure in a fast-paced environment.

- Thorough understanding of insurance billing processes, payment posting procedures, and regulatory requirements.

- Familiarity with healthcare compliance standards and audit procedures.

- Proficient in Microsoft Office

Responsibilities:

- Lead the contracting process with payers, from initial negotiations to final agreement execution, ensuring favorable terms and optimal reimbursement rates.

- Manage insurance profile setup to support contracting activities, ensuring accurate and comprehensive data entry.

- Administer portal access for internal stakeholders, maintaining security protocols and user permissions.

- Generate and analyze reports related to contracting performance and other managed care operations, providing actionable insights to inform decision-making.

- Handle cash posting activities, reconciling payments, and addressing discrepancies to ensure accurate financial reporting.

- Process enrollments, including ERNs (Electronic Remittance Notices) and EOBs (Explanation of Benefits), accurately and in a timely manner.

- Coordinate insurance audits, and prepare documentation and supporting materials to ensure compliance and regulatory adherence.

- Collaborate cross-functionally to streamline processes and enhance operational efficiency within the managed care department.

- Stay abreast of industry trends, regulatory changes, and best practices related to managed care contracting and operations.

Job Type: Full-time

Pay: $45,000.00 - $55,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Application Question(s):

• Do you have any experience contracting in the DME healthcare industry?

Education:

• Bachelor's (Preferred)

Experience:

• Contract management: 2 years (Required)

Ability to Commute:

• Spring, TX 77380 (Required)

Ability to Relocate:

• Spring, TX 77380: Relocate before starting work (Required)

Work Location: Hybrid remote in Spring, TX 77380