1 Centene Corporation jobs in Clayton
Managed Care Contracting Analyst
Posted 10 days ago
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Job Description
Job Type
Full-time
Description
Who We Are:
Nimble solutions has over 20 years of specialized, surgical-focused revenue cycle management experience that spans across the Ambulatory Surgical Center industry and other affiliated services adjacent to the ASC space, such as anesthesia billing services, professional billing services, transcription services, and many others.
Why You'll Want To Work At Nimble!
We provide services in nearly every US state, and our team of experts works around the globe, managing over $10 billion in net revenue as we continue to build and innovate a world-class organization with people like you.
Together, we embrace challenges, fuel innovation, and strive to exceed expectations. Healthcare means a lot more to us. We care about creating an environment where our coworkers, clients, and communities' social, financial, and physical health is at the forefront of everything we do.
What you'll be doing day to day.
The Managed Care Contracting Analyst is responsible for implementing and maintaining nimble's managed care contracting strategy in a multi-state environment, and we are looking for candidates to join the Managed Care Department who are eager to learn in a fast-paced 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
Who You Are!
- 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
- Office setting- This is an onsite position.
- Participate in departmental training and staff meetings
- Adhere to all compliance and company policies and procedures
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