Managed Care Coordinator

St. Catherine Of Siena Smithtown , NY 11787

Posted 3 months ago

Job Details

Catholic Health Services of Long Island (CHS) is an integrated health care delivery system with some of the region's finest health and human services agencies. CHS includes six hospitals, three skilled nursing facilities, a regional home nursing service, hospice and a multiservice, community-based agency for persons with special needs. Under the sponsorship of the Diocese of Rockville Centre, CHS serves hundreds of thousands of Long Islanders each year, providing care that extends from the beginning of life to helping people live their final years in comfort, grace and dignity.

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.


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Managed Care Coordinator

St. Catherine Of Siena