Contract Specialist - Managed Care

The Contract Specialist serves as a liaison between all Inova providers and managed care payers. Assists Directors, AVP, and VP with managed care operations and support, including ad-hoc projects associated with contract negotiations and renewals, which drive significant economic value throughout all phases of the contract lifecycle in support of maximizing the value of one of Inova's most critical assets: its managed care agreements, which generate north of $3.5B annually. Ensures key contractual milestones related to the performance of all assigned contracts are being met appropriately. Establishes and maintains effective working relationships with external payers and internal departments to prepare for and lead joint operating committee meetings with the payers and internal meetings with service line leadership. Works with the analytics team to monitor clinical and contract performance. Monitors and summarizes regulatory and payer policy updates to communicate to internal stakeholders. Performs assigned administrative functions.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules

Contract Specialist - Managed Care Job Responsibilities:

• Works closely with facilities to understand specific problems associated with each functional area and to translate those needs into actionable events in contract negotiations.
• Negotiates single case agreements, monitors for payment, and reports financial impact.
• Proactively identifies actions which are necessary to ensure timely notice of key contract events.
• Analyzes and makes recommendations for improvement or optimization of current contracts.
• Maintains and actively pursues information related to managed care trends and mergers and acquisitions and communicates to internal stakeholders.
• Maintains and actively pursues information related to payer policy updates, summarizes such updates, works with the analytics team to determine the financial impact of such updates, and communicates updates to internal stakeholders.
• Seeks awareness of new laws and regulations related to Managed Care and the Revenue Cycle.
• Establishes and maintains effective relationships with Inova facility and system operational management, as well as Inova Patient Financial Services, to maximize contract performance yield.
• Establishes and maintains effective working relationships with external payers and internal departments to prepare for and lead joint operating committee ("JOC") meetings with the payers.
• Works with the analytics team to create standard reports and KPIs that will be discussed during each JOC, service line, and department meeting and presents such reports and KPIs at the applicable JOC, service line or department meeting.

Contract Specialist - Managed Care Requirements:

• Education: Bachelor's Degree OR Associate and 4 additional years of experience OR HS Diploma/GED and 8 additional years of experience
• Experience: 3 years of Managed Care/ healthcare experience

Contract Specialist - Managed Care Preferred Requirements:

• Experience collaborating with internal departments (Patient Financial Services, Revenue Cycle, Case Management) to ensure contract compliance and reimbursement optimization.
• An understanding of quality programs and performance metrics.
• Ability to analyze payment methods and provide feedback to improve reimbursement outcomes.
• Ensuring and understanding of compliance with payor reimbursement policies to assess impacts on managed care contracts.
• Expertise in negotiating Single Case Agreements for out-of-network services.
• Ability to maintain an organized contract depository system with regular audits.
• In-depth knowledge of healthcare industry trends and ability to translate regulatory changes.
• Excellent communication skills with the ability to liaise with payors, ensure contract adherence, and support strategic initiatives in collaboration with leadership.
• Experience with educating team members, on managed care processes to promote operational efficiencies.