MANAGED CARE & CONTRACT SPECIALIST

Apis Services Inc•Philadelphia, PA

1d•Onsite

About The Position

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.

Requirements

High School Diploma or GED required
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
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
Must comply with: HIPAA regulations OSHA and safety standards Organizational policies and procedures

Nice To Haves

Associate’s degree preferred
Experience with: Medicaid systems (e.g., ePromise) EHR systems Billing and reporting tools

Responsibilities

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