Managed Care Manager

FacilityWyckoff Heights Medical Center
DepartmentFaculty Practice
CategoryFull Time
Job Details

Under the general supervision of the Director of Credentials, with independent decision making, will assist in the management of and serve as a liaison between the Managed Care/Provider Enrollment Department of Wyckoff Heights Medical Center and its various Insurance Carriers to enroll Providers into various participating plans of the Medical Center.  Will perform all duties in a manner consistent with Wyckoff Heights Medical Center’s commitment to providing superior patient care and promoting good guest relations.

*  Liaison between Providers and Insurance Carriers, Billing Vendor, and various collection agencies. 

*  Oversees enrollment of providers into Health Plans (delegated and non-delegated), including, but not limited to:

   - Maintenance of delegated master files.

   - Reporting of all additions, terminations, and changes to the delegated health plans as needed, but no less than monthly, and maintaining proof of these submissions.

   - Preparation, submission, and follow-up of provider applications for non-delegated health plans.

*  Oversees maintenance and updates of provider credentials for continued participation in Health Plans.

*  Reviews provider contracts on a regular basis to ensure compliance.

*  Performs site visits as necessary or requested.

*  Coordinates with the Credentials Department for the delegated health plans annual audit.

*  Coordinates with the Credentials Department for credentialing reports to the delegated health plans as mandated in the delegation agreements.

*  Coordinates with the Director of Credentials to create and update Provider Enrollment policies and procedures.

*  Builds and maintains the Apogee Database.

*  Ad hoc reporting as needed.

*  Answers calls, mailings.

*  Performs all other duties as required by the department with relations to Managed Care and Provider Enrollment.

*  Ability to train/orient new employees in provider enrollment processes and use of the Apogee Database.

Position Requirements:

 This position requires a minimum formal education of an Associate’s Degree or equivalent and a minimum of 3 year job-related experience.

 Desired (not required) criteria include:  Effective verbal, written and organizational skills. Knowledge of CMS, NCQA, State and Federal regulations related to health plan credentialing activities.

   Computer knowledge, including working knowledge of Microsoft Office and MSOW Credentialing Software.

 CPCS or CPMSM certification required or 3 years experience in a credentials or managed care setting with certification obtained within 5 years.

*  Self-starter and self-motivated, functions independently with minimal direction. Maintains professional demeanor and confidentiality. Flexible, team player. Must be able to work with a

    variety of people and circumstances.




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Position Available2018-05-08 19:06:00

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