Managed Care Coordinator
: Job Details :

Job Description: Description Job Summary: Provides coordination for the facility enrollment process with managed care organizations (e.g. insurance payers, networks, insurers) for the company's multi-state clinics to ensure clinic participation. Communicates effectively with external and internal customers (e.g. Revenue Cycle Management, Finance, Operations, and clinical staff) in order to resolve issues related to managed care contract requirements and reimbursement. Essential Functions: ● Communicate with external and internal customers to obtain necessary documentation for accurate and timely application/contract submissions ● Act as a liaison with managed care organization representatives and manage contractual relationships appropriately. ● Provide ongoing administrative support for internal customers for plan participation and rate schedules ● Work collaboratively with Revenue Cycle Management and clinical teams for claim and authorization denials for specific plans ● Maintains a thorough knowledge of reimbursement methodologies, contractual terms, billing, and other operational factors needed for contract implementation and maintenance. ● Proactively identifies and works toward renewals, reevaluations, etc., to maintain integrity and clinic status with the managed care organizations. ● Negotiates reimbursement rates in order to increase the percentage being offered for all lines of business ● Maintains knowledge of managed care organization requirements for facility enrollment with payers. ● Maintains the required level of confidentiality when communicating with employees at all levels. Uses sound judgment and discretion when relaying information that is of a confidential nature. ● Is reliable and engaged and provides feedback on processes and policies. ● Attends all department, team, and company meetings as required. ● Maintains appropriate confidence to maintain and protect business operations. ● Other duties as assigned Supervisory Responsibilities: (Scope of the person's authority, including a list of jobs that report to this job). ● None Essential Qualifications: (To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the competencies (minimum knowledge, skill, and ability) required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions). Education/Licensure/Certification: This position requires a Bachelor's degree in business or related field. Required Knowledge: The candidate has knowledge of the credentialing and contracting process with third party healthcare insurance plans. Knowledge of major U.S. health plans, NPI Registry, taxonomies, EIN/Tax ID and governmental payer entities. Must be familiar with computers, medical terminology, ICD-10 and CPT coding, and modifiers. Experience Required: This position requires a minimum of 3-5 years experience in either the payer or provider environment. Demonstrated ability in resolving complex issues is required. Experience with behavioral healthcare organizations are a plus. Skill and Ability: The candidate has the ability to work collaboratively with colleagues. Represent the company in a professional manner. Strong organizational skills with a keen ability to prioritize and multitask. Ability to adhere to and meet deadlines. Good communicator (oral and written). Strong administrative and data management skills. Ability to raise issues proactively and in a timely manner. Strong presentation skills Ability to work with software systems.