Medicaid Managed Care Liaison

Job Summary:

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The Medicaid Managed Care Liaison is the primary contact person for the Medicaid Managed Care Plans (MMCP). MMC Liaison must have experience, expertise, and knowledge of:

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  The child welfare system

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  Foster care healthcare requirements

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  The unique complex needs of the foster care population

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  Medicaid Managed Care policies and procedure

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  The Medicaid Managed Care Liaison is a full-time position.

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Duties and Responsibilities:

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29I Core Services

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Coordinate with MCO (Managed Care Organization) Foster Care Liaison

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Inform and coordinate PCP (Primary Care Physician) changes

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Assist with plan enrollment, disenrollment, and transitions

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Issue plan Welcome letters

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Secure plan ID showing effective date

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Assist in ID card replacement

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Assist with foster care placement changes including: - Access to health care - Facilitate a single case agreement when a child is placed outside of the MMCP’s service area or provider network

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Interact with clinical and billing staff

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Refer children for needed services and assist in provider selection

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Coordinate with health care providers, including school and community-based services

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Maintain eligibility for public or private health insurance

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Assist with consent and/or confidentiality issues

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Obtain authorizations from all MCO

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Update the AccuMedic (EHR) system with the authorization information to ensure proper billing occurs

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Health Services Supervisor

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Take care of general office duties such as answering telephone and triaging calls, maintaining office supplies, preparing time sheets, and maintaining clinical staff schedules in Microsoft Outlook.

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  Assist Foster Care and Group Home programs with Access to care.

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  Oversee and support program audits

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  Responsible for closed medical records

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  Arrange Single Case Agreements with out of network placements

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  Billing and Clinical Staff interaction

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  Referrals to services

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  Coordinate care with providers including schools and Community Based services.

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  Assist with consent / confidentiality issues.

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  Assist with Fair Hearings / court ordered services.

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  Schedule clinical appointments, make reminder calls, and track kept and not kept appointments.

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  Create and maintain tickler system for child-specific mandated services in developmental and mental health treatment.

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  Type clinical reports memos letters, and other reports for the department.

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  Photocopy, distribute, and file reports and other written materials.

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  Log and distribute requests for clinical services to appropriate staff.

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  Distribute and track completed clinical reports.

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  Track Continuing Education credits, licensure, and malpractice insurance of clinicians.

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  Prepare and maintain records of department purchases.

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  Handle incoming and outgoing mail for the department.

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  Maintain up-to-date treatment case lists on each clinician.

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  Interact with clinical and billing staff

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  Oversees all business functions

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  Perform other secretarial duties as requested by Medical Director.

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  Any other related duties as required

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Educational & Experience Requirements:

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Experience:

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Minimum 3 years’ experience in a medical or social services office environment.

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Knowledge and use of computers.

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Experience with Electronic Health Records a plus.

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Excellent Typing skills.

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Excellent Data entry skills.

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Familiar with NYS Child Welfare protocols.

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Organizational skills.

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Good Communication and collaboration skills.

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Required background checks:

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NYS Statewide Central Register of Child Abuse and Maltreatment (SCR)

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NYS Sex Offender Registry (SOR)

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NYS Division of Criminal Justice Services (DCJS) fingerprinting

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NYS Justice Center Staff Exclusion List (SEL)

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NYS OMIG Medicaid Exclusion List

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Complete mandated reporter training

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Education:

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High school diploma – minimum; BA/ BS/ MPA preferred

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Job Type: Full-time

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Salary: $35,000.00 - $38,000.00 per year

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Benefits:

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  Dental insurance

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  Employee assistance program

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  Employee discount

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  Flexible spending account

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  Health insurance

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  Health savings account

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  Life insurance

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  Paid time off

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  Retirement plan

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  Tuition reimbursement

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  Vision insurance

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