Client Services Representative, Managed Care

Client Services Representative, Managed Care

Houston, United States of America | Full time | Hybrid | R1534888

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About Cedar Gate Technologies

Cedar Gate Technologies is an IQVIA business that enables payers, providers, employers, and service administrators to excel at value-based care. Our unified technology and services platform enhances and automates data management activities to deliver employer and provider analytics, care management, and payment technology necessary to pursue every payment model and optimize performance in all lines of business. From primary care attribution to bundled payments to capitation, our platform is designed to improve clinical, financial, and operational outcomes for all.

Position Summary

Join Cedar Gate Technologies, an IQVIA business, as a Managed Care Services Representative! We're looking for a dynamic new employee to help shape and manage our provider, payer, and facility contracts. In this role, you'll develop, negotiate, implement, monitor, and optimize managed care agreements that support our growth and quality of care. You'll stay on top of industry trends, communicate contract changes across the organization, and analyze performance data to ensure agreements deliver the expected results.

As a Managed Care Services Representative, you'll also collaborate closely with internal teams, clients, payers, and providers, building strong relationships and preparing presentations - with the chance to lead or co-present on key initiatives.

Roles & Responsibilities

• Act as a key liaison between internal teams, providers, and payers - resolving managed care issues, assisting with provider communications, and researching claims to maintain strong relationships.
• Collaborate with Team members to manage and maintain our Center of Excellence programs, including member education, helpline, enrollment, and reporting.
• Support clients, providers, and payers with a focus on timely and effective inquiry resolution.
• Build and nurture positive relationships with providers, payers, and internal stakeholders to support seamless operations.
• Research managed care trends and benchmarks to provide analysis and recommendations.
• Prepare data and insights to support negotiations with payers, employers, and providers; present findings to senior leadership.
• Collaborate with team members and department leadership to prepare and present documentation for Committee and Board meetings, ensuring accuracy and compliance.
• Assist with the review of payer and provider agreements and help develop negotiation strategies.
• Prepare and present quarterly payer account summaries to departmental leadership.
• Partner with other departments to ensure smooth workflows and accurate contract and provider information.
• Support client onboarding by managing payer and provider contract details.
• Track agreement statuses (expirations, changes, notices) and proactively alert management to required actions.
• Maintain and validate data across systems (including Cactus and other platforms) to ensure accuracy and completeness.
• Monitor payer updates in policies and procedures and distributing pertinent information to the appropriate teams in a timely manner.
• Create, organize, and maintain provider and payer contracting documents in both electronic and paper formats.
• Coordinate with provider offices to secure the timely completion of documents and distribute executed agreements properly.
• Maintain organized systems, filing structures, and resources to support department efficiency.
• Assist with special projects and additional tasks as assigned.

Job Location

Houston, TX

Work Arrangement

Hybrid - Flexibility of working from home for 2 days and collaborating in office for 3 days per week

Required Experience / Qualifications

• BS/BA in healthcare administration, business, finance, or related field; relevant work experience may be considered
• 3 or more years of experience in healthcare contracting or business operations, including reporting, managed care contracting, and patient account resolution with a provider or payer.
• Strong knowledge of CPT, HCPCS and ICD-10 coding
• Extensive Microsoft Office experience, including PowerPoint and Advanced Excel skills with knowledge of pivot tables, Power Queries, and complex formulas
• Superior written and verbal communication skills
• Possess a positive attitude and a willingness to learn
• Ability to work well under pressure by efficiently prioritizing and managing multiple tasks to meet performance expectations and deadlines
• Strong critical thinking and analytical skills
• Experience in analyzing and interpreting reports for financial trends in the provider contracting arena
• Self-motivated and team-oriented
• Exceptional customer service skills with a professional, businesslike image to clients, visitors, internal staff, and the public
• Currently eligible to work in the U.S. without any assistance in getting a U.S. employment visa or work authorization.
• Experience with claims payment resolution

Preferences - Either Have or Can Learn & Develop

• symplr, practice management system(s), and SSQ or other reporting systems experience
• Experience working in a Cardiology setting, Cardiology terminology and coding

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com

IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex,