Summary
The Managed Care & Contract Administrator supports the contracting and reimbursement strategy for infusion therapy providers by managing payer contracts, analyzing fee schedules, and assisting with negotiations. This role plays a critical part in ensuring accurate reimbursement, contract compliance, and optimization of payer relationships. The Specialist works closely with internal teams and external payers to gather, interpret, and maintain insurance contract documentation while identifying opportunities for improved financial performance.
Duties and Responsibilities
Obtain, organize, and maintain copies of client payer contracts, amendments, and related documentation.
Review managed care agreements to identify reimbursement methodologies, fee schedules, escalators, carve-outs, and contract terms.
Abstract key contract terms and enter data into internal contract management or tracking systems.
Identify contract discrepancies, gaps, or unfavorable terms impacting reimbursement.
Research and analyze payer fee schedules for infusion services, drugs, and supplies.
Compare contracted rates against benchmarks, Medicare, and market standards.
Support reimbursement modeling and financial impact analyses for new and existing contracts.
Assist with resolving payer reimbursement issues related to contract interpretation.
Prepare negotiation summaries, talking points, and supporting data for payer discussions.
Participate in payer outreach and follow-up related to contract negotiations and renewals.
Track negotiation status, payer responses, and outcomes.
Support implementation of new or amended contracts post-execution.
Collaborate with billing, finance, clinical, and leadership teams to ensure accurate contract interpretation and implementation.
Serve as a subject matter resource for managed care contract questions.
Support client-facing communications related to payer contracts and reimbursement findings.
Ensure contract documentation is current, accurate, and audit-ready.
Monitor contract effective dates, renewals, and termination timelines.
Maintain confidentiality and compliance with all regulatory and contractual requirements.
Qualifications
7 or more years of experience in managed care contracting, payer relations, reimbursement, or healthcare finance.
5 or more years of experience working with fee schedules, rate analysis, and contract terms.
Bachelor’s degree (or higher) or equivalent experience
Strong understanding of commercial insurance contracts and reimbursement methodologies.
High attention to detail with strong analytical and organizational skills.
Proficiency in Microsoft Excel and document management tools.
Ability to manage multiple clients, priorities, and deadlines.
Preferred
Experience in infusion therapy, specialty pharmacy, oncology, or outpatient healthcare services.
Familiarity with Medicare reimbursement and payer benchmarking.
Experience supporting or participating in payer contract negotiations.
Knowledge of CPT/HCPCS codes related to infusion services.
Why work at Altus Biologics?
Competitive Salary
Daytime Hours
Weekends Off
Paid Time Off
9 Company Paid Holidays
Diverse Workforce
Corporate & On-The-Job training
Health Benefits
Retirement Plan
Altus Biologics provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.This policy applies to all terms and conditions of employment, including recruiting and hiring.
In addition, all employees are expected to adhere to the Altus Biologics' Code of Conduct, Compliance policies and all applicable federal, state, and local laws and regulations. Altus Biologics employees are expected to report any concerns about compliance or business practices to his or her immediate supervisor, appropriate management and/or the Chief Compliance Officer.
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