Wyckoff Heights Medical Center
Managed Care Coordinator
Wyckoff Heights Medical Center, Brooklyn, New York, United States, 11210
Wyckoff Heights Medical Center (WHMC) is seeking a Managed Care Coordinator to work under the oversight of the VP of Managed Care and Faculty Practice. As a member of the Managed Care Team, you will be responsible for coordinating and facilitating managed care provider and facility enrollment including network participation activities on behalf of Wyckoff Heights Medical Center. They will work closely and collaboratively with the Insurance Payors as well as serve as a liaison to the Faculty Practice physicians/ practitioners and other stakeholders (Patient Financial Investigators, Billing Office, Medical Staff, external billing companies, practice managers, etc.).
Ensures compliance of managed care companies and payment rules with negotiated contracts. Works closely with other members of the Managed Care team and Patient Financial Services and/or the Central Billing Office to identify trends and opportunities in outstanding Accounts Receivables Serves as the liaison between physician offices, business offices, and Insurance Payors. Coordinates engagement and education of physician offices Assists in the negotiation and maintenance of physician managed care contracts Responsible for assignment, dissemination, and administrative management of inquiries received including distribution of any educational material and notifications Ensure all MCO compliance documents are completed and responded to according to the terms of the MCO contract and timeframes. Responsible for the data intake of WHMC providers for the purpose of enrolling a provider in a managed care organization or other payer ("MCO") network. Work collaboratively with WHMC providers to collect, capture and process the following information: Enrollment Packet with supporting documentation; Department Managed Care checklist; Demographic data; and Participation Information. For MCO's not under a delegated agreement: Complete enrollment applications, paper change forms, CAQH profile or other method established by the MCO within time frames required by MCO. Coordinate provider enrollment activities to ensure timely provider submissions to MCOs e.g. Delegated/Non-Delegated (CAQH) providers. Notify the MCO of provider demographic/participation statuses. In accordance with the terms of the delegated credentialing agreement, providers are to be enrolled within ninety (60) days of roster submission. Inform Vice President of Managed Care of MCOs non-compliance. A provider enrollment roster should be sent, at a minimum, once per month to the MCO or as required by the delegated credentialing agreement in place between the MCO and WHMC. Upon receipt of the provider's participation status, notify key stakeholders of the ID number and effective date. Keep accurate communication records. Upon notice of a change in a provider's demographic data, licensure or certification, update delegated credentialing electronic roster for each assigned MCO and email to MCO within twenty-four (24) hours of receipt of demographic change. Upon notice of a provider's termination from WHMC, update delegated credentialing electronic roster and email to MCO within twenty-four (24) hours of receipt of termination notice or according to the terms of the delegated agreement. For MCO's not under a delegated agreement: Complete paper change form, CAQH profile or other method established by the MCO within timeframes required by MCO. Gather and review data for reporting purposes to meet Managed Care Departments delegated by credentialing contractual obligations. Depending on MCO, monthly, quarterly, semiannual and/or annual reporting of provider database roster reviews are a requirement of the delegated credentialing agreement. Upon notice from the MCO, furnish the report or roster review within the timeframe required by delegated credentialing agreement. At the request of the MCO, we review Managed Care Departments provider database for accuracy. If incorrect, follow MCO's policy and procedure for reporting incorrect or incomplete information. Conduct quality assessments for all databases that are created and/or maintained by Managed Care Department. If the findings are unsatisfactory, contact the WHMC provider/MCO to discover the reason. Make updates/corrections where possible. Escalate all questions and inquiries to the Vice President of Managed Care. Maintain the integrity of all Managed Care Departments databases by continuously auditing the data that is collected and distributed. Communicate effectively with the Managed care team and other key stakeholders to gather, assess and resolve inconsistencies. Some examples of data reviews that assist in maintaining data integrity are as follows: Quarterly Database Review, Internal and External Roster Review, Monthly Expirable Management Review, Service Location Review, Billing Address Review. Maintain vital relationships with MCO's by addressing all inquiries in a timely fashion. Work with WHMC team members to resolve various inquiry types that are related to provider enrollment. Such as, but are not limited to, the following: Claim denials; Authorization issues; Provider participation inquiries; Transferring of member panel inquiries; and Provider location inquiries. As needed, direct questions and escalations to the Vice President of Managed Care. For non-Clinical Practice provider groups, review, analyze, and report on various data sets deemed necessary by the department. Such as, but not limited to, the following: Database Update Review Tracker and/or Report, Managed Care Department Roster Submission Tracker and/or Report, Monthly Status Report. Attend, participate and/or facilitate professional development activities. Actively participate in workshops, meetings, training programs and/or other professional activities deemed necessary by the Vice President of Managed Care. Develop and distribute notifications to internal WHMC team members. Work collaboratively with Managed Care Team members to develop and distribute the departmental newsletter(s), and/or other forms of notifications as outlined in departmental workflows and/or advised by the Vice President of Managed Care. As appropriate, facilitate regularly scheduled meetings with MCO's to build and maintain open lines of communication and to foster collaboration for provider enrollment and facility credentialing/re-credentialing initiatives. As it pertains to credentialing, maintain current knowledge of NCQA, TJC, CMS and NYS laws and regulations. Review the following for MCO's: newsletters, policy updates and other notifications that directly affect Managed Care Department Team workflow(s). Direct questions regarding revised law, regulatory guidelines and MCO correspondence with the Vice President of Managed Care. Conduct data entry for credentialing software. Responsible for the timely processing and tracking of provider enrollment data e.g. Provider ID numbers and Effective Dates. Add, update, and maintain the integrity of the data that is entered into the electronic credentialing database daily. Ensure that all data is current. Escalate all database expirable issues or data integrity issues to the Vice President of Managed Care. For providers not in the credentialing database, conduct data entry in applicable electronic database. Add, update and maintain the integrity of the data that is entered into the electronic database. Ensure that all the data is current. Coordinates and implements credentialing activities to assist WHMC facilities with the completion of MCO facility credentialing/re-credentialing applications for MCO network contract offerings; monitors and follows-up as needed. Conduct data entry for Managed Care Department in the electronic database. Responsible for the timely processing and tracking of facility demographic data, including services rendered at each facility location. Add, update, and maintain the integrity of the data that is entered into the electronic facility credentialing database daily. Ensure that all data is current. Conducts provider managed care enrollment and facility credentialing and re-credentialing activities; communicates with practice plan administration or hospital staff to obtain requisite credentialing information to facilitate timely completion and submission of required documents. Escalate all database issues or data integrity issues to the Vice President of Managed Care. Establishes and manages relationships with internal team members as it relates to PCMH. Monitors to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Required Qualifications:
This position requires a minimum formal education of High School Diploma or equivalent and a minimum of 3 years job-related experience. Bachelor's Degree preferred Minimum of three (3) years of direct experience in enrolling clinical health care providers either within a health care delivery organization or group of moderate or significant size or on behalf of a managed care organization or payer. Direct experience with NYS Medicaid and Medicare enrollment and recertification preferred Direct experience with managed care enrollment or credentialing and re-credentialing. Experience setting up and managing the Council for Affordable Quality Healthcare (CAQH) profiles. Knowledge of NCQA, TJC, CMS and New York State Education Department and New York State Department of Health Laws as they pertain to credentialing. Demonstrate project management skills and be proficient in database management. Analytical experience is a plus. Demonstrate background in healthcare credentialing policy and management. Strong interpersonal and communication skills, proven research and analytical skills, and ability to handle multiple priorities. Ability to follow, read and interpret managed care delegated credentialing contracts. Proficient in the Microsoft Office software, and Google software. Preferred Qualifications:
Technology savvy: excellent understanding of processes and databases; proficient with Excel, Word, and PowerPoint. The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is required. Excellent oral and written communication skills. Displays a high degree of decorum and professionalism when dealing with stakeholders. Ability to solve problems and prioritize issues. Take a thoughtful approach to issue resolution.
Non-Union
Days: Mon - Fri
Shift: 8am - 4pm
Annual Salary: $67,000
#WyckoffHP
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Ensures compliance of managed care companies and payment rules with negotiated contracts. Works closely with other members of the Managed Care team and Patient Financial Services and/or the Central Billing Office to identify trends and opportunities in outstanding Accounts Receivables Serves as the liaison between physician offices, business offices, and Insurance Payors. Coordinates engagement and education of physician offices Assists in the negotiation and maintenance of physician managed care contracts Responsible for assignment, dissemination, and administrative management of inquiries received including distribution of any educational material and notifications Ensure all MCO compliance documents are completed and responded to according to the terms of the MCO contract and timeframes. Responsible for the data intake of WHMC providers for the purpose of enrolling a provider in a managed care organization or other payer ("MCO") network. Work collaboratively with WHMC providers to collect, capture and process the following information: Enrollment Packet with supporting documentation; Department Managed Care checklist; Demographic data; and Participation Information. For MCO's not under a delegated agreement: Complete enrollment applications, paper change forms, CAQH profile or other method established by the MCO within time frames required by MCO. Coordinate provider enrollment activities to ensure timely provider submissions to MCOs e.g. Delegated/Non-Delegated (CAQH) providers. Notify the MCO of provider demographic/participation statuses. In accordance with the terms of the delegated credentialing agreement, providers are to be enrolled within ninety (60) days of roster submission. Inform Vice President of Managed Care of MCOs non-compliance. A provider enrollment roster should be sent, at a minimum, once per month to the MCO or as required by the delegated credentialing agreement in place between the MCO and WHMC. Upon receipt of the provider's participation status, notify key stakeholders of the ID number and effective date. Keep accurate communication records. Upon notice of a change in a provider's demographic data, licensure or certification, update delegated credentialing electronic roster for each assigned MCO and email to MCO within twenty-four (24) hours of receipt of demographic change. Upon notice of a provider's termination from WHMC, update delegated credentialing electronic roster and email to MCO within twenty-four (24) hours of receipt of termination notice or according to the terms of the delegated agreement. For MCO's not under a delegated agreement: Complete paper change form, CAQH profile or other method established by the MCO within timeframes required by MCO. Gather and review data for reporting purposes to meet Managed Care Departments delegated by credentialing contractual obligations. Depending on MCO, monthly, quarterly, semiannual and/or annual reporting of provider database roster reviews are a requirement of the delegated credentialing agreement. Upon notice from the MCO, furnish the report or roster review within the timeframe required by delegated credentialing agreement. At the request of the MCO, we review Managed Care Departments provider database for accuracy. If incorrect, follow MCO's policy and procedure for reporting incorrect or incomplete information. Conduct quality assessments for all databases that are created and/or maintained by Managed Care Department. If the findings are unsatisfactory, contact the WHMC provider/MCO to discover the reason. Make updates/corrections where possible. Escalate all questions and inquiries to the Vice President of Managed Care. Maintain the integrity of all Managed Care Departments databases by continuously auditing the data that is collected and distributed. Communicate effectively with the Managed care team and other key stakeholders to gather, assess and resolve inconsistencies. Some examples of data reviews that assist in maintaining data integrity are as follows: Quarterly Database Review, Internal and External Roster Review, Monthly Expirable Management Review, Service Location Review, Billing Address Review. Maintain vital relationships with MCO's by addressing all inquiries in a timely fashion. Work with WHMC team members to resolve various inquiry types that are related to provider enrollment. Such as, but are not limited to, the following: Claim denials; Authorization issues; Provider participation inquiries; Transferring of member panel inquiries; and Provider location inquiries. As needed, direct questions and escalations to the Vice President of Managed Care. For non-Clinical Practice provider groups, review, analyze, and report on various data sets deemed necessary by the department. Such as, but not limited to, the following: Database Update Review Tracker and/or Report, Managed Care Department Roster Submission Tracker and/or Report, Monthly Status Report. Attend, participate and/or facilitate professional development activities. Actively participate in workshops, meetings, training programs and/or other professional activities deemed necessary by the Vice President of Managed Care. Develop and distribute notifications to internal WHMC team members. Work collaboratively with Managed Care Team members to develop and distribute the departmental newsletter(s), and/or other forms of notifications as outlined in departmental workflows and/or advised by the Vice President of Managed Care. As appropriate, facilitate regularly scheduled meetings with MCO's to build and maintain open lines of communication and to foster collaboration for provider enrollment and facility credentialing/re-credentialing initiatives. As it pertains to credentialing, maintain current knowledge of NCQA, TJC, CMS and NYS laws and regulations. Review the following for MCO's: newsletters, policy updates and other notifications that directly affect Managed Care Department Team workflow(s). Direct questions regarding revised law, regulatory guidelines and MCO correspondence with the Vice President of Managed Care. Conduct data entry for credentialing software. Responsible for the timely processing and tracking of provider enrollment data e.g. Provider ID numbers and Effective Dates. Add, update, and maintain the integrity of the data that is entered into the electronic credentialing database daily. Ensure that all data is current. Escalate all database expirable issues or data integrity issues to the Vice President of Managed Care. For providers not in the credentialing database, conduct data entry in applicable electronic database. Add, update and maintain the integrity of the data that is entered into the electronic database. Ensure that all the data is current. Coordinates and implements credentialing activities to assist WHMC facilities with the completion of MCO facility credentialing/re-credentialing applications for MCO network contract offerings; monitors and follows-up as needed. Conduct data entry for Managed Care Department in the electronic database. Responsible for the timely processing and tracking of facility demographic data, including services rendered at each facility location. Add, update, and maintain the integrity of the data that is entered into the electronic facility credentialing database daily. Ensure that all data is current. Conducts provider managed care enrollment and facility credentialing and re-credentialing activities; communicates with practice plan administration or hospital staff to obtain requisite credentialing information to facilitate timely completion and submission of required documents. Escalate all database issues or data integrity issues to the Vice President of Managed Care. Establishes and manages relationships with internal team members as it relates to PCMH. Monitors to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Required Qualifications:
This position requires a minimum formal education of High School Diploma or equivalent and a minimum of 3 years job-related experience. Bachelor's Degree preferred Minimum of three (3) years of direct experience in enrolling clinical health care providers either within a health care delivery organization or group of moderate or significant size or on behalf of a managed care organization or payer. Direct experience with NYS Medicaid and Medicare enrollment and recertification preferred Direct experience with managed care enrollment or credentialing and re-credentialing. Experience setting up and managing the Council for Affordable Quality Healthcare (CAQH) profiles. Knowledge of NCQA, TJC, CMS and New York State Education Department and New York State Department of Health Laws as they pertain to credentialing. Demonstrate project management skills and be proficient in database management. Analytical experience is a plus. Demonstrate background in healthcare credentialing policy and management. Strong interpersonal and communication skills, proven research and analytical skills, and ability to handle multiple priorities. Ability to follow, read and interpret managed care delegated credentialing contracts. Proficient in the Microsoft Office software, and Google software. Preferred Qualifications:
Technology savvy: excellent understanding of processes and databases; proficient with Excel, Word, and PowerPoint. The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is required. Excellent oral and written communication skills. Displays a high degree of decorum and professionalism when dealing with stakeholders. Ability to solve problems and prioritize issues. Take a thoughtful approach to issue resolution.
Non-Union
Days: Mon - Fri
Shift: 8am - 4pm
Annual Salary: $67,000
#WyckoffHP
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.