What are the responsibilities and job description for the Managed Care Coordinator position at Tandym Group?
A health services network in Florida is currently seeking a new Managed Care Coordinator to join their growing team in Orange County. In this role, the Managed Care Coordinator will be responsible for providing coordination for the facility enrollment process with managed care organizations for the company's multi-state clinics to ensure clinic participation.
About the Opportunity :
Schedule : Monday to Friday (3 days onsite; 2 days WFH)
Hours : 8am to 5pm
Setting : 3 days onsite; 2 days WFH (flexible on days)
Responsibilities :
Communicate with external and internal customers to obtain necessary documentation for accurate and timely application / contract submissions
Act as a liaison with managed care organization representatives and manage contractual relationships appropriately
Provide ongoing administrative support for internal customers for plan participation and rate schedules
Work collaboratively with Revenue Cycle Management and Clinical teams for claim and authorization denials for specific plans
Maintain a thorough knowledge of reimbursement methodologies, contractual terms, billing, and other operational factors needed for contract implementation and maintenance
Proactively identify and work toward renewals, reevaluations, etc., to maintain integrity and clinic status with the managed care organizations
Negotiate reimbursement rates in order to increase the percentage being offered for all lines of business
Maintain knowledge of managed care organization requirements for facility enrollment with payers
Maintain appropriate confidence to maintain and protect business operations
Perform other duties, as needed
Qualifications :
3 years of experience in either the Payers and / or Provider environment
Bachelor's Degree in a related field
Knowledge of the Credentialing and Contracting process with Third Party Healthcare Insurance plans
Knowledge of major U.S. health plans, NPI Registry, taxonomies, EIN / Tax ID and governmental payer entities
Working knowledge of Medical terminology, ICD-10 & CPT coding, and Modifiers
Computer savvy
Demonstrated ability in resolving complex issues
Desired Skills :
Experience with Behavioral Healthcare organizations
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