MANAGED CARE & CONTRACT SPECIALIST

Managed Care & Client Contract SpecialistPosition SummaryThe Managed Care & Client Contract Specialist is responsible for ensuring compliance and operational readiness across all IDD (Intellectual and Developmental Disabilities) and BHH (Behavioral Health Home) service locations. This role oversees provider enrollment requirements, managed care contracts, Medicaid eligibility, and client financial agreements.The Specialist ensures all regulatory, contractual, and operational requirements are met, while supporting program teams and collaborating with Revenue Cycle Management (RCM) to maintain accurate billing, reduce denials, and ensure continuity of services.Key ResponsibilitiesManaged Care & Contract ManagementManage and maintain all Managed Care Organization (MCO) and private insurance contractsReview, update, and organize contract repository to ensure accuracy and accessibilitySupport communication with state systems (e.g., eMOMED/Incserv) for required reporting documentationMonitor contract renewals and ensure timely updatesProvider Enrollment & ComplianceMaintain ePromise revalidation tracker and ensure timely completion of provider enrollment requirementsAssist with preparation and submission of state business licensesEnsure all service locations remain compliant with regulatory and payer requirementsMaintain accurate compliance records and tracking reportsMedicaid Eligibility & Authorization SupportConduct ongoing Medicaid eligibility checks for all clientsMonitor eligibility status and notify program teams of changes or issuesSupport alignment between eligibility, authorizations, and billing processesClient Contracts & Accounts CoordinationCollaborate with Program leadership to:Create and maintain Room & Board/client contractsUpdate contract terms and rates as neededGenerate monthly invoices and track client accounts receivable (AR)Act as liaison between Program teams and RCM regarding:Billing discrepanciesRep payee coordinationOutstanding balancesReporting & Data ManagementMaintain accurate tracking systems for:RevalidationsContractsEligibilityClient financial agreementsUtilize Excel and other systems to analyze data and generate reportsEnsure data accuracy across systems impacting billing and complianceTraining & Process ImprovementProvide training and guidance to program staff on:Contract processesEligibility requirementsCompliance expectationsIdentify process gaps and recommend improvements to:Enhance accuracyReduce denialsImprove workflow efficiencyAdministrative SupportAssist in evaluating and improving workflows related to:RevalidationsEligibility checksRoom & Board processesContract managementPerform additional duties as assigned by leadershipQualificationsEducation & ExperienceHigh School Diploma or GED requiredAssociate's degree preferredValid Driver's license for a minimum of 3 years2+ years of experience in:IDD, BHH, healthcare billing, or complianceMedicaid-funded servicesTechnical SkillsAdvanced proficiency in Microsoft Excel, including working with large datasetsExperience with:Medicaid systems (e.g., ePromise)EHR systemsBilling and reporting toolsCore CompetenciesStrong attention to detail and accuracyExcellent organizational and time-management skillsStrong analytical and problem-solving abilitiesEffective written and verbal communication skillsAbility to manage multiple priorities and deadlinesAbility to work independently and collaborativelySolution-oriented mindset with a focus on continuous improvementWorking Conditions & RequirementsWork is primarily performed in a professional office environmentAbility to sit for extended periods and use standard office equipmentOccasional lifting, bending, and movement as neededMust comply with:HIPAA regulationsOSHA and safety standardsOrganizational policies and proceduresAbout Company:Apis Services, Inc. (a wholly owned subsidiary of Inperium, Inc.) provides a progressive platform for delivering Shared Services to Inperium and its Constellation of affiliate companies. Allowing these entities to advance their mission and vision. By exploring geographical program expansion and focusing on quality outcome measures to create cost savings that result in reinvestment into the organizations stakeholders through capacity creation and employee compensation betterment. Apis Services, Inc. and affiliate's provide equal employment opportunities for all employees and applicants for employment in compliance with all federal and all applicable state and local laws and regulations, including nondiscrimination in hiring and employment. All employment decisions are made without regard to race, color, religion, gender, national origin, ancestry, age, sexual orientation, gender identity and expression, disability, genetic information, marital status, pregnancy/childbirth, veteran status or any other basis protected by law. This policy of non-discrimination and equal employment opportunities extends to every phase and aspect of hiring and employment.

Created: 2026-04-02