Managed Care Specialist

PLEASE POST CONSPICUOUSLY

OTSEGO COUNTY HASTHE FOLLOWING VACANCY:

Community Services Department

Managed Care Specialist

$41,342 - $48,777

DATED: April 7, 2025

LAST DAYFOR FILING: April 18, 2025

EOE

DISTINGUISHING FEATURES OF THE CLASS The work involves managing and overseeing contracts related to the delivery of behavioral health services and coordinating enrollment into managed care programs. This includes collecting, preparing and analyzing data; providing billing services, correcting errors and tracking payments; monitoring the effectiveness of services; identifying opportunities for improving performance and reporting progress on performance measures. The work is performed under general supervision by the Business Office Manager. Oversight of others performing related activities. Does related work as required.

TYPICAL WORKACTIVITIES (Illustrative only)

• Responsible for identifying and ensuring that all available health insurance resources are utilized to offset medical expenses incurred by clients of the agency;
• Compile and review documents required for managed care, insurance, Medicaid, Medicare and other payer contracts;
• Record and maintain accurate contract information in billing system and monitor compliance;
• Provide education and oversight to support and clinical staff to assure compliance with billing processes;
• Provide billing services, correct errors and track payment;
• Complete credentialing information and applications with clinical staff;
• Prepare application for organization’s participation in performance based agreements and other related activities;
• Compile and review data to measure performance, clinical outcomes and identify problems, gaps;
• Attends meetings, as directed, serving as the County’s designated representative;
• Does related work as required.

FULL PERFORMANCE KNOWLEDGE, SKILLS, AND ABILITIES: Good knowledge of Medicaid/ Medicare/Managed Care and insurance policies and procedures reimbursement for behavioral health services. An understanding of HIPPA and Corporate Compliance regulations. Knowledge of NYS OMH and OASAS regulations. Demonstrated ability to perform electronic billing, data collection and analysis; ability to communicate effectively both verbally and in writing; ability to write clear and accurate reports and maintain records as required; ability to enter, retrieve and interpret information in central computerized systems; ability to establish and maintain effective relationships with clients, staff and providers; ability to work independently; initiative and tact.

MINIMUM QUALIFICATIONS Graduation from high school or possession of a high school equivalency diploma; AND

(a) Graduation from a regionally accredited or New York State registered college with an Associate's Degree or higher and one (1) year of full-time or its part-time equivalent experience in healthcare business operations; or

(b) Satisfactory completion of a minimum of 60 semester credit hours in a regionally accredited or New York State registered college and two (2) years of full-time or its part-time equivalent experience in healthcare business operations; or

(c) Three (3) years of full-time or its part-time equivalent experience in healthcare business operations.

SPECIAL REQUIREMENTS:

Possession of a Credentialed Certified Professional Coder (CPC) certification is required within six (6) months of appointment and continued educational trainings must be maintained throughout employment.

Note: Successful completion of coursework in business administration, healthcare administration or closely related field at a regionally accredited college or university, or one accredited by the New York State Board of Regents to grant degrees, may be substituted for up to one (1) year of the required experience with three (3) semester credit hours of related coursework as indicated above being equivalent to three (3) months of experience.

CLASSIFICATION: Competitive

Applications available at the Otsego County Personnel/Civil Service Department, 183 Main Street, Cooperstown, NY 13326 or online at www.otsegocountyny.gov

Job Type: Full-time

Pay: $41,342.00 - $48,777.00 per year

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Shift:

• Day shift

Work Location: In person

Salary : $41,342 - $48,777