Out-of-Network Contract Liaison
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Job Description
UM contract liaison negotiating out-of-network agreements and authorizations. Supporting MedPOINT Management’s IPA operations and managed care services.
Responsibilities:
- Facilitate out-of-network (OON) contract negotiations between providers and health plans
- Coordinate with the Utilization Management (UM) team to support OON authorization requests and approvals
- Communicate with out-of-network providers regarding single-case agreements and reimbursement terms
- Track and document OON contract statuses, agreements, and correspondence in internal systems
- Collaborate with claims, UM, and network development teams to resolve OON billing and authorization issues
- Ensure compliance with state and federal regulations related to OON services and managed care contracting
- Prepare and maintain reports on OON activity, trends, and cost containment outcomes
Requirements:
- 2+ years of experience in managed care, utilization management, or healthcare contracting
- Familiarity with out-of-network provider negotiations and single-case agreements
- Knowledge of IPA, HMO, and managed care operations strongly preferred
- Strong understanding of medical terminology, CPT/ICD-10 codes, and authorization processes
- Excellent communication and negotiation skills with internal and external stakeholders
- Proficiency in healthcare management systems and Microsoft Office Suite
- Highly organized, detail-oriented, and able to manage multiple priorities simultaneously
- Legally authorized to work in the US
Benefits:
- 401(k)
- 401(k) matching
- Bonus based on performance
- Company parties
- Dental insurance
- Employee discounts
- Health insurance
- Opportunity for advancement
- Paid time off
- Parental leave
- Savings bank
- Training & development
- Vision insurance
- Wellness resources
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