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Managed Care Coordinator

Company: Good Shepherd Hospice
Location: Melville
Posted on: June 8, 2021

Job Description:

Managed Care Coordinator

Facility: CHS Services Inc Location: Melville, NY Department: Managed Care Category: Newly Created Position Schedule: Full Time Shift: Day shift Hours: 9:00AM-5:00PM ReqNum: 6034079

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes. Catholic Health is also proud to be voted one of Newsday's Top Places to Work on Long Island in 2018 and 2019 and Modern Healthcare's Best Place to work in both 2019 and 2020.

Duties and Responsibilities

Primary:

Responsible for maintaining and updating managed care contract rate grids

Assists in the maintenance of Joint Operating Committee action plans and follow ups.

Works with relevant parties to ensure deliverable from all parties are achieved in accordance with strategic timelines.

Maintains CHSLI master list of service locations (facility, professional and continuing care)

Assists in the resolution of referral, authorization and claims payment issues

Supports Directors in effort to educate and assist Hospital departments in meeting internal and MCO operational requirements. Informs departments of contract terms as necessary

Responsible for the completion of facility credentialing for managed care payers. Accurately maintains all facility credentialing files

Assists Directors in payer research for new programs/services

Assists in the maintenance contractual term matrix and contact grids

Assists in the coordination of payer in-services

Disseminates quarterly payer policy updates

Maintains and updates contact and plan participation grids

Maintains Payer Contracts

Tracks single case agreement through execution process

Coordinates Center of Excellence application correspondence.

Educates and assists CHSLI employees in meeting internal and MCO operational requirements. Informs departments of contract terms for all entities

Secondary:

Works with Revenue Cycle team to identify and resolve issues related to timely payment of managed care claims.

Assists SVP and VP on projects as assigned

Position Requirements and Qualifications

EDUCATION: Bachelor's degree required.

SKILLS:

Proficient in designing, building reports and analyses in various Microsoft based data analysis tools.

Proven experience working with large and complex SQL databases preferred.

Ability to analyze and accurately summarize complex claims data and effectively communicate conclusions

Proficient in project management

Detail oriented and strong organization skills

EXPERIENCE:

Previous experience with analysis preferably in a healthcare or managed care setting.

Experience with hospital billing and or decision support systems a plus.

Strong knowledge of the managed care environment including provider, payer, and employer.

At Catholic Health Services of Long Island your well-being comes first, with comprehensive compensation and benefits; our offerings go beyond the basics. In addition to multiple medical plans, life insurance, generous paid time off and flexible spending accounts, we also offer substantial tuition reimbursement, an employer funded pension plan and several savings plan options for your future.

Keywords: Good Shepherd Hospice, New Haven , Managed Care Coordinator, Other , Melville, Connecticut

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