Managed Care Coordinator - CHHA

Assists with the planning, implementation and coordination of managed care activities related to assigned Team. Supports Hospital's mission to provide the highest quality care by complying with regulatory guidelines, meeting agency standards, and obtaining appropriate certification.

JOB DUTIES / RESPONSIBILITIES

ESSENTIAL DUTIES

1. Assists Managed care department with securing necessary summaries, documentation and insurance information as needed.

2. Acts as the liaison for the managed care department and staff.

3. Assists with the completion of open enrollment and insurance verification and updating of authorizations for Managed Care Team.

4. Provide coverage for Managed Care Team in the event of staffing shortage to include authorizations submissions, follow up with Insurance companies regarding auth status.

5. Update Managed Care Census and send out notification to field clinicians with updates when next auth review set and when advance notification when documentation is due.

6. Assist CHHA team with securing Initial Authorization for new admissions when needed.

7. Assists with the preparation of monthly reports for managed care admissions, payments, and other required analyses.

8. Updates and maintains the managed care resource library, i.e. plans lists / materials.

9. Assists with the utilization management of the assigned Team, including monitoring insurance coverage of daily admissions for the Team and coordinates follow-up discussions for managed care children.

10. Assists with the preparation of managed care in-service material/staff resources, i.e. Clinical Case Manager In-Service for the Team.

11. Coordinates programs consistent with the managed care strategy, including managing research projects.

12. Assists with the development of managed care policies and procedures.

13. Performs various clerical tasks as necessary, including typing, copying, distribution, and faxing.

14. Other duties as assigned and required.

NONESSENTIAL DUTIES

15. Performs duties for the Team as appropriate.

16. Performs other related duties and activities as may become necessary or as directed by the Team Supervisor or Supervisor of Managed Care Coordinators and CI Department.

17. Generates mailings, assembles and updates marketing materials, assist in follow-up activities for PPO's Medicaid Managed Care Plans, and CHIP plan contracts as assigned for the Team.

18. Updates and maintains the Team filing system and database.

19. Determines the need for office supplies and maintains inventory.

Qualifications

Formal education required:

Associates Degree required, Masters in Health Care preferred.

Previous experience required:

Minimum of 1 year health care experience, managed care experience preferred.

Experience with and understanding of New York State health care regulations, policies and provider reimbursement. Understanding of CHHA operations and industry desirable.

Proficiency in word processing and spreadsheet applications required.

Excellent communication, planning, and organization skills.

Formal education required:

Associates Degree required, Masters in Health Care preferred.

Previous experience required:

Minimum of 1 year health care experience, managed care experience preferred.

Experience with and understanding of New York State health care regulations, policies and provider reimbursement. Understanding of CHHA operations and industry desirable.

Proficiency in word processing and spreadsheet applications required.

Excellent communication, planning, and organization skills.

Join our fabulous team of professionals where big hearts help little patients!

We RECOGNIZE ability and REWARD excellence. We offer a competitive salary and generous benefits:

• Excellent individual/family benefits
• Generous paid time off
• Tuition reimbursement
• Life insurance
• Flexible spending accounts
• 403(b) retirement plan

St. Mary's Healthcare System for Children is committed to nurturing a compassionate environment that welcomes all children, young adults, families, and staff; built on the belief that what makes us different makes us stronger, and provides unity throughout our community

St. Mary's Healthcare System for Children is an Equal Opportunity Employer

M/F/D/V/SO