Specialist, LTC Network Management (Information Technology)

Who We Are:

Managed Health Care Associates, Inc. (MHA), provides care communities with access, solutions, and insights to help them run their businesses more effectively. Our members include post-acute providers across the care continuum including long-term care, home infusion, and specialty pharmacies, as well as senior living and other group living facilities. Our team of associates are passionate about our common mission of helping people age with grace, and champion our core values of being Curious Learners, Selfless Advocates, and Relentless Finishers.

Who we're looking for:

The Specialist, LTC Network Management will be the main contact for the Senior LTC Network Administrator and Manager of LTC Network Operations. Responsibilities include managing the Med B Payer Network, collaborating with Finance on Med D billing, and updating pharmacies. This role addresses Med B payer enrollment questions, resolves conflicts, and handles ad hoc inquiries from pharmacies and payers.

Additionally, the role supports the HME/DME team with Med B Payer Network onboarding, changes, and billing. The ideal candidate should have pharmacy and insurance experience, strong communication skills, and the ability to collaborate with team members and other departments.

What You'll Be Doing:

Med D Network and Billing/Compliance

• Collaborate with the Senior LTC Network Administrator for quarterly Med D Network billing, compliance, and credentialing.
• Handle ad hoc and annual credentialing requests from Med D Network partners.
• Maintain and send data to Finance for quarterly Med D Network invoicing and update NetSuite.
• Stay updated on Med B Payer and Med D Network billing and credentialing terms.
• Support the Med D Network team with information changes, credentialing, and compliance.

Med B Payer Network Management

• Coordinate the Med B Payer Network with payers, suppliers, and members in HME/DME.
• Handle credentialing, utilization requests, and reviews.
• Update Payer Contract Rosters monthly (28 contracts).
• Submit quarterly Member Payer Rosters.
• Keep Salesforce and Laserfiche updated with member info.
• Resolve claim issues as a liaison.
• Retrieve member info from the MED website.
• Share utilization info and updates from Payer contracts.
• Obtain current client listings from payers.
• Review payer contracts for profitability.
• Provide Finance with invoicing data monthly and assist Accounting with collections and NetSuite updates.

 Sales Support and Education

• Provide ongoing support and education to the sales team and members (both Home Infusion and DME members) on Med B Payer Network.
• Collaborate with sales to develop and execute growth strategies for the HME/DME division, driving market share and revenue expansion.
• Analyze market trends, payer dynamics, and competitive landscapes to provide actionable insights that support business development and strategic initiatives.

Relationship Management and Account Support

• Lead and maintain strong, strategic relationships with payers within the Med B Payer Network, ensuring alignment with business goals and network growth.
• Serve as a liaison between sales and key stakeholders, ensuring alignment of goals and objectives related to the HME/DME network's strategic growth.

System and Process Optimization

• Finalize and optimize the transition of the Metagroup website, Salesforce integration, and other internal systems to enhance operational efficiency and user experience.
• Coordinate/collaborate with other departments for the implementation of software or upgrades/updates to current systems, ensuring they meet contract standards and facilitate proper filing of all pertinent documents, emails, and information.

  What You'll Bring to the Table:

• High School diploma or equivalent and relevant experience required. College Degree preferred.
• 2-5 years' experience with LTC Pharmacy & Network Contracting
• 2-5 years' experience with, and working knowledge of, Medicare Part B
• Proficient in Microsoft 365
• Ability to provide subject matter expertise and technical expertise to resolve member needs and issues with Med B payer network participation agreement
• Ability to establish rapport and build relationships with members and business partners
• A strong ability to work cross-functionally within MHA
• Excellent, communication and customer services skills required
• High degree of detail and organizational skills
• Detail Oriented, Organized, Results Driven, Develop Standards, Foster Teamwork, Handle Pressure

What's Good to Know:

• Hybrid work environment

Why Join MHA
MHA continues to lead by providing purpose-driven and value-based solutions, which preserve the dignity and grace people deserve, regardless of age. Let us be the best place you'll ever work!

Our associates enjoy the following benefits, and you can, too!

• Staying Healthy
  Comprehensive medical, dental, and vision plans with FSA/HSA options
  Fitness reimbursement
  Access to an Employee Assistance Program
• Enjoying Time-Off
  Paid time off, holidays, personal days, paid parental leave, plus your Birthday is a day off!
• Planning for the Future
  Life Insurance, short-term & long-term disability insurance
  401K match
  Employee Stock Purchase Plan
  Voluntary financial and legal benefits, through our benefits providers
• Learning Continuously
  E-learning programs
  Tuition Reimbursement
  Ongoing Team Trainings
• Making an Impact
  Paid volunteer time-off
  Donation matching

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c) Administration