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Role Description

The Specialist is responsible for identifying and securing public and private insurance contracts; reviews and organizes existing contracts. Assists with the development of potential relationships with strategic partners and creates measurable business results for various markets.

Essential Job Functions

• Works in partnership with Operations Leaders and Director of Contracts and Payor Engagement to ensure consistency and secure public and private insurance contracts.
• Analyzes and monitors financial aspects of existing contracts and maintains original documentation of all contracts.
• Identifies, contacts, and creates relationships with potential payors that result in new contracts and increased funding possibilities for program participants.
• Conducts rate and contract negotiations.
• Describes services provided to potential contract sources.
• Communicates with state directors, and state operating/marketing staff regarding contract specifics. Ensures commitments to participants, family, referral sources and payors are met.
• Communicates contract executions and requirements to all internal departments.
• Completes contract related credentialing and enrollment application requirements.
• Maintains database of licenses, accreditation forms, financial and organizational information for the purpose of efficient and timely enrollment application.
• Oversees Single Case Agreement process within the Admissions Teams. May take lead in difficult single case negotiation.
• Facilitates resolution of contract related issues with billing and collections team.
• Performs other related duties and activities as required.

Qualifications

• Bachelor’s degree in Rehabilitation Administration, Business Administration or related field preferred.
• Three to five years’ experience with contracts, managed care, and health insurance related industry preferred.

Requirements

• Two to three years’ experience with healthcare contract negotiations, managed care, and health insurance.
• At least one year of experience with commercial contract negotiations.
• Major Payor experience with: Aetna, BCBS, Cigna, Workers Comp, etc.

Physical Requirements

• Sedentary work.
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body.
• Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Americans with Disabilities Act Statement

External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job functions either unaided or with assistance of a reasonable accommodation to be determined on a case by case basis via the interactive process.