Posted:
8/28/2025, 11:20:32 PM
Location(s):
West Virginia, United States
Experience Level(s):
Junior ⋅ Mid Level ⋅ Senior
Field(s):
Customer Success & Support
Workplace Type:
Hybrid
Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.
As a Payer Contract Specialist, you will collect and assimilate managed care contract information to support contract implementation, compliance monitoring, operations and customer service functions. Working within a dynamic Managed Care Department that negotiates agreements across a wide range of services, you will disseminate information to provide organizations, facilities and operational areas while recommending resolutions to claim payment, reimbursement and related issues. You will also be responsible for pushing contract data to Joint Venture partners such as Amazon One Medical, Select Rehab and Regent Ambulatory Surgery, as well as supporting the onboarding and maintenance of new Regional PPO contracts.
A caregiver in this position works remotely from 8:00 a.m. – 5:00 p.m.
A caregiver who excels in this role will:
Collect and assimilate managed care contract information to support contract implementation, compliance monitoring, operations and customer service functions.
Act as an internal resource to community hospitals, institutes and other internal departments.
Provide contract-specific information and resolution of issues to payors and internal customers.
Research, track and manage issues related to claim payment, reimbursement, operations and general information requests.
Manage and track escalated, high-profile and highly complex issues, making recommendations to resolve them.
Negotiate case-specific agreements with local, regional, national and international payors for tertiary referrals, as well as agreements for other services and Cleveland Clinic facilities.
Gather, research and distribute contract-related information for compilation, communication and implementation.
Prepare communications, summary sheets, quick reference guides and implementation checklists for assigned payor contracts.
Contribute materials for the Managed Care newsletter and websites.
Coordinate informational sessions for payor contract implementation and education.
Arrange and facilitate meetings with payor representatives for contract maintenance or problem resolution.
Provide dedicated production support for the contract management process, focusing on audit and reconciliation of data across multiple systems, including iValua, OnBase (Legal), EPIC (CMA), and STRATA (Strategic Pricing), to mitigate administrative and financial risks.
Push contract data to Joint Venture partners such as Amazon One Medical, Select Rehab, and Regent Ambulatory Surgery.
Support the onboarding and maintenance of approximately 15 new Regional PPO contracts.
Minimum qualifications for the ideal future caregiver include:
Bachelor's Degree in Business, Marketing, Healthcare or a related field OR High School Diploma/GED and three years of related experience
Strong desktop computer skills (Word, Excel, Access, PowerPoint, Outlook)
Preferred qualifications for the ideal future caregiver include:
One year of managed care or provider relations experience
Managed care background at payer or provider
Knowledge of contracting process and managed care
Knowledge of insurance, processing insurance claims and negotiating insurance contracts with a provider
Provider relations experience
Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/
Physical Requirements:
Manual dexterity to produce materials on a PC, normal or corrected vision, extensive sitting, ability to clearly communicate verbally by phone and in person.
Personal Protective Equipment:
Follows standard precautions using personal protective equipment as required.
The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.
Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.
Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.
Please review the Equal Employment Opportunity poster.
Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities
Website: https://clevelandclinic.org/
Headquarter Location: Cleveland, Ohio, United States
Employee Count: 1001-5000
Year Founded: 1921
IPO Status: Private
Last Funding Type: Grant
Industries: Health Care ⋅ Hospital ⋅ Medical ⋅ Non Profit