Managed Care CoordinatorFacility:CHS Services IncLocation:Melville, NYDepartment:Managed CareCategory:Newly Created PositionSchedule:Full TimeShift:Day shiftHours:9-5ReqNum:6025305Catholic 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 ResponsibilitiesPrimary:Responsible for maintaining and updating managed care contract rate gridsAssists 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 issuesSupports Directors in effort to educate and assist Hospital departments in meeting internal and MCO operational requirements. Informs departments of contract terms as necessaryResponsible for the completion of facility credentialing for managed care payers. Accurately maintains all facility credentialing filesAssists Directors in payer research for new programs/servicesAssists in the maintenance contractual term matrix and contact gridsAssists in the coordination of payer in-servicesDisseminates quarterly payer policy updatesMaintains and updates contact and plan participation gridsMaintainsPayer ContractsTracks single case agreement through execution processCoordinates Center of Excellence application correspondence.Educates and assists CHSLI employees in meeting internal and MCO operational requirements.Informs departments of contract terms for all entitiesSecondary: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 assignedPosition Requirements and QualificationsEDUCATION: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 conclusionsProficient in project managementDetail oriented and strong organization skillsEXPERIENCE: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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