Summary Description:
The Sr. Managed Care Contract Manager will act as the catalyst between the contract, contract parties and the data. Supporting the negotiation process by defining the financial impact for payment structures and reimbursement methodologies during the negotiation process will be a critical part of this role. You will assure adherence to the contract language, evaluate validity in the data and support the Managed Care Contract Team at Baycare Health Partners. The Sr. Managed Care Contract Manager, will also perform research and collect data to find patterns, trends, and insights that can help in decision-making and planning. You will be responsible for contract data modeling, creation of actionable reporting and development of performance dashboards for all levels within the organization.
Job Requirements:
1) This position will serve as a team lead and technical expert on reimbursement and regulatory rules
2) Will be responsible for hospital Medicare and Medicaid cost report filings, audits, and settlements
3) Will advise and support budgeting, month-end close, regulatory changes, and audit adjustments related to Medicare and Medicaid
4) As a Sr. Managed Care Contract Manager this position will serve as team lead and technical expert related to manage care contracts
5) Will support director with payer contract negotiations, quantitative analysis and report preparation as it relates to managed care payer contracts
6) Ensures successful contract negotiation through their knowledge of regulatory requirements, government reimbursement, organizational initiatives, and strong payer relationships
7) Developing dashboards and ad-hoc reporting with minimal guidance
8) Will advise and support budgeting, month-end close, regulatory changes, and audit adjustments related to Medicare and Medicaid
9) Performs complex data analysis and contract modeling support of ad-hoc and standing management or customer requests.
10) Collaborates with cross-functional teams, including clinical, technical and finance teams.
11) Validates data extracts and analyzes any data variances.
12) Conduct service line managed care reimbursement analysis as requested by Management.
13) Works in conjunction with applicable teams to develop value-based contract measures and metrics and applying such to reimbursement models and provider level tracking.
14) Manages the calculation and implementation of contract escalation language and system impacts.
15) Identifies and integrates data from multiple sources and builds reimbursement models, dashboards and reports within the various platforms, and other available reporting tools that produce interactive and effective data analytics in support of managed care contracting functions.
16) Develops and performs routine and ad-hoc reporting to evaluate performance and to identify opportunities for process improvements.
17) Performs statistical analysis of data extracted from various internal sources and prepares reports based on findings.
18) Proactively identifies data trends and outliers and provides suggestions to the causes, remedies, or process improvements in compliance with payment regulation and market guidance.
19) Responsible for data and information compilation, design, and analysis; developing and designing clear and concise reports for distribution to internal and external customers.
20) Acts as managed care contract analytics SME on multi-disciplinary teams charged with the maintenance development of enterprise-wide technical systems. Creates, and maintains business process and technical workflow documents.
Minimally Required Experience:
Candidates should have a strong background in managed care, with a minimum of 5-7 years of experience in roles related to managed care contracting. This includes negotiating, analyzing, and managing contracts with healthcare providers, insurance companies, or other healthcare organizations.
Skills/Competencies:
Contract Negotiation: Demonstrated success in negotiating complex managed care contracts is essential. This includes experience with fee schedules, reimbursement rates, and contract terms.
Financial Analysis: Proficiency in financial analysis and modeling is important for assessing the financial impact of managed care contracts and making informed decisions.
Regulatory Knowledge: A solid understanding of healthcare regulations, compliance, and reimbursement methodologies, such as Medicare, Medicaid, and commercial insurance, is essential to ensure contracts are in compliance with legal requirements.
Data Analysis: Experience in data analysis and the ability to interpret healthcare utilization data, claims data, and financial reports is often required to evaluate the performance of managed care contracts and make data-driven decisions.
Project Management: Experience in managing contract-related projects and initiatives is beneficial, as Senior Managed Care Contract Managers may oversee the implementation and execution of new contracts.
Negotiation Skills: Strong negotiation skills are essential for securing favorable contract terms and resolving disputes effectively.
Technology Proficiency: Familiarity with contract management software and healthcare information systems can be advantageous.
Strategic Thinking: The ability to think strategically and contribute to the organization's long-term managed care strategy is often expected in senior roles.
Problem-Solving
**You Belong At Baystate**
At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.
DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.
**Education:**
Bachelors Degree (Required)
**Certifications:**
**Equal Employment Opportunity Employer**
Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.
The Sr. Managed Care Contract Manager will act as the catalyst between the contract, contract parties and the data. Supporting the negotiation process by defining the financial impact for payment structures and reimbursement methodologies during the negotiation process will be a critical part of this role. You will assure adherence to the contract language, evaluate validity in the data and support the Managed Care Contract Team at Baycare Health Partners. The Sr. Managed Care Contract Manager, will also perform research and collect data to find patterns, trends, and insights that can help in decision-making and planning. You will be responsible for contract data modeling, creation of actionable reporting and development of performance dashboards for all levels within the organization.
Job Requirements:
1) This position will serve as a team lead and technical expert on reimbursement and regulatory rules
2) Will be responsible for hospital Medicare and Medicaid cost report filings, audits, and settlements
3) Will advise and support budgeting, month-end close, regulatory changes, and audit adjustments related to Medicare and Medicaid
4) As a Sr. Managed Care Contract Manager this position will serve as team lead and technical expert related to manage care contracts
5) Will support director with payer contract negotiations, quantitative analysis and report preparation as it relates to managed care payer contracts
6) Ensures successful contract negotiation through their knowledge of regulatory requirements, government reimbursement, organizational initiatives, and strong payer relationships
7) Developing dashboards and ad-hoc reporting with minimal guidance
8) Will advise and support budgeting, month-end close, regulatory changes, and audit adjustments related to Medicare and Medicaid
9) Performs complex data analysis and contract modeling support of ad-hoc and standing management or customer requests.
10) Collaborates with cross-functional teams, including clinical, technical and finance teams.
11) Validates data extracts and analyzes any data variances.
12) Conduct service line managed care reimbursement analysis as requested by Management.
13) Works in conjunction with applicable teams to develop value-based contract measures and metrics and applying such to reimbursement models and provider level tracking.
14) Manages the calculation and implementation of contract escalation language and system impacts.
15) Identifies and integrates data from multiple sources and builds reimbursement models, dashboards and reports within the various platforms, and other available reporting tools that produce interactive and effective data analytics in support of managed care contracting functions.
16) Develops and performs routine and ad-hoc reporting to evaluate performance and to identify opportunities for process improvements.
17) Performs statistical analysis of data extracted from various internal sources and prepares reports based on findings.
18) Proactively identifies data trends and outliers and provides suggestions to the causes, remedies, or process improvements in compliance with payment regulation and market guidance.
19) Responsible for data and information compilation, design, and analysis; developing and designing clear and concise reports for distribution to internal and external customers.
20) Acts as managed care contract analytics SME on multi-disciplinary teams charged with the maintenance development of enterprise-wide technical systems. Creates, and maintains business process and technical workflow documents.
Minimally Required Experience:
Candidates should have a strong background in managed care, with a minimum of 5-7 years of experience in roles related to managed care contracting. This includes negotiating, analyzing, and managing contracts with healthcare providers, insurance companies, or other healthcare organizations.
Skills/Competencies:
Contract Negotiation: Demonstrated success in negotiating complex managed care contracts is essential. This includes experience with fee schedules, reimbursement rates, and contract terms.
Financial Analysis: Proficiency in financial analysis and modeling is important for assessing the financial impact of managed care contracts and making informed decisions.
Regulatory Knowledge: A solid understanding of healthcare regulations, compliance, and reimbursement methodologies, such as Medicare, Medicaid, and commercial insurance, is essential to ensure contracts are in compliance with legal requirements.
Data Analysis: Experience in data analysis and the ability to interpret healthcare utilization data, claims data, and financial reports is often required to evaluate the performance of managed care contracts and make data-driven decisions.
Project Management: Experience in managing contract-related projects and initiatives is beneficial, as Senior Managed Care Contract Managers may oversee the implementation and execution of new contracts.
Negotiation Skills: Strong negotiation skills are essential for securing favorable contract terms and resolving disputes effectively.
Technology Proficiency: Familiarity with contract management software and healthcare information systems can be advantageous.
Strategic Thinking: The ability to think strategically and contribute to the organization's long-term managed care strategy is often expected in senior roles.
Problem-Solving
**You Belong At Baystate**
At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.
DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.
**Education:**
Bachelors Degree (Required)
**Certifications:**
**Equal Employment Opportunity Employer**
Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.
Job ID: 488134591
Originally Posted on: 8/5/2025
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