Job Description

Hyderabad, Telangana, IND o Managed Care Contracting

Job Type

Full-time

Description

Who We Are

nimble solutions is a leading provider of revenue cycle management solutions for ambulatory surgery centers (ASCs), surgical clinics, surgical hospitals, and anesthesia groups. Our tech-enabled solutions allow surgical organizations to streamline their revenue cycle processes, reduce administrative burden, and improve financial outcomes. Join more than 1,100 surgical organizations that trust nimble solutions and its advisors to bring deep insights and actionable intelligence to maximize their revenue cycle.

Job Summary

The Assistant Manager - Provider Credentialing & Managed Care Contracting is responsible for managing provider credentialing processes and supporting all aspects of managed care contract administration across Ambulatory Surgery Centers (ASCs). This role involves contract loading, payment variance analysis, chargemaster audits, and reimbursement analytics to ensure accurate and timely payer setup and optimal revenue realization.

Key Responsibilities

Payment Variance CalculatorsCreate and maintain facility-specific calculators by identifying top commercial payers. Update calculators based on commercial rate changes and effective dates. Support Payment Posting team with ThoughtSpot reports and contract profile analysis.

Contract Loading & MaintenanceLoad Medicare contracts quarterly and commercial contracts periodically in the Practice Management System (PMS). Create and update contract profiles, including carve-outs, exemptions, and rate changes. Track contract end dates and ensure timely updates based on Medicare fee schedules and payer updates.

Chargemaster & Code-to-Rate AnalysisPerform chargemaster analysis using 12-month billed charges and reports Conduct periodic audits and maintenance of chargemaster data Execute code-to-rate analysis for specific CPT codes

Reimbursement & Metrics AnalysisAnalyze implant reimbursement and multiple-of-Medicare scenarios based on facility needs Extract and compile metrics from payer contracts and PDFs for internal reporting

Contractual Adjustments & Workflow TasksReview contract rates in response to operational team queries regarding contractual adjustments not taken Manage daily tasks received through the C3PO workflow tool from departments like coding, charges, payment posting, and AR

Contract Loading Tracker & CPT MaintenanceMaintain and regularly update the contract loading tracker Ensure accurate CPT code loading in the PMS

CredentialingOversee provider credentialing and re-credentialing processes across ASC facilities Ensure timely submission and follow-up with payers for credentialing approvals Maintain accurate credentialing records and documentation

Requirements

Qualifications

Bachelor's degree in healthcare administration, Business, or related field (master's preferred). 6-10 years of experience in provider credentialing and managed care contracting. Strong knowledge of Medicare and commercial payer reimbursement methodologies. Proficiency in Practice Management Systems, Excel, and reporting tools (e.g., ThoughtSpot). Excellent analytical, organizational, and communication skills.

Preferred Qualifications

Experience with ASC operations and revenue cycle workflows Familiarity with CPT/HCPCS coding, chargemaster structures, and payer contract terms Ability to manage multiple priorities and meet deadlines in a dynamic environment

Logistics

Location: Hyderabad Department: Managed Care Contracting Reports To: Senior Vice President Employment Type: Full-Time * Shift timings: 6PM to 3AM IST (night shift)