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
Responsible for maintaining and updating managed care contract
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
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
Assists Directors in payer research for new
Assists in the maintenance contractual term matrix and contact
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
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.
Proficient in designing, building reports and analyses in
various Microsoft based data analysis tools.
Proven experience working with large and complex SQL databases
Ability to analyze and accurately summarize complex claims data
and effectively communicate conclusions
Proficient in project management
Detail oriented and strong organization skills
Previous experience with analysis preferably in a healthcare or
managed care setting.
Experience with hospital billing and or decision support systems
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.