MANAGED CARE & CONTRACT SPECIALIST

Job Description

Job Description

Managed Care & Client Contract Specialist Position Summary

The 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.

• Manage and maintain all Managed Care Organization (MCO) and private insurance contracts

• Review, update, and organize contract repository to ensure accuracy and accessibility

• Support communication with state systems (e.g., eMOMED/Incserv ) for required reporting documentation

• Monitor contract renewals and ensure timely updates

• Maintain ePromise revalidation tracker and ensure timely completion of provider enrollment requirements

• Assist with preparation and submission of state business licenses

• Ensure all service locations remain compliant with regulatory and payer requirements

• Maintain accurate compliance records and tracking reports

• Conduct ongoing Medicaid eligibility checks for all clients

• Monitor eligibility status and notify program teams of changes or issues

• Support alignment between eligibility, authorizations, and billing processes

• Collaborate with Program leadership to:

  • Create and maintain Room & Board/client contracts

  • Update contract terms and rates as needed

• Generate monthly invoices and track client accounts receivable (AR)

• Act as liaison between Program teams and RCM regarding:

  • Billing discrepancies

  • Rep payee coordination

  • Outstanding balances

• Maintain accurate tracking systems for:

  • Revalidations

  • Contracts

  • Eligibility

  • Client financial agreements

• Utilize Excel and other systems to analyze data and generate reports

• Ensure data accuracy across systems impacting billing and compliance

• Provide training and guidance to program staff on:

  • Contract processes

  • Eligibility requirements

  • Compliance expectations

• Identify process gaps and recommend improvements to:

  • Enhance accuracy

  • Reduce denials

  • Improve workflow efficiency

• Assist in evaluating and improving workflows related to:

  • Revalidations

  • Eligibility checks

  • Room & Board processes

  • Contract management

• Perform additional duties as assigned by leadership

• High School Diploma or GED required

• Associate’s degree preferred

• Valid Driver's license for a minimum of 3 years

• 2+ years of experience in:

  • IDD, BHH, healthcare billing, or compliance

  • Medicaid-funded services

• Advanced proficiency in Microsoft Excel , including working with large datasets

• Experience with:

  • Medicaid systems (e.g., ePromise)

  • EHR systems

  • Billing and reporting tools

• Strong attention to detail and accuracy

• Excellent organizational and time-management skills

• Strong analytical and problem-solving abilities

• Effective written and verbal communication skills

• Ability to manage multiple priorities and deadlines

• Ability to work independently and collaboratively

• Solution-oriented mindset with a focus on continuous improvement

• Work is primarily performed in a professional office environment

• Ability to sit for extended periods and use standard office equipment

• Occasional lifting, bending, and movement as needed

• Must comply with:

  • HIPAA regulations

  • OSHA and safety standards

  • Organizational policies and procedures

About 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.