Managed Care Coordinator

FacilityWyckoff Heights Medical Center
CategoryFull Time
Job Details

* Responsible for updating and submitting provider credentialing data in delegated credentialing spreadsheets to applicable MCOs on a monthly basis or as


*  Obtains individual provider applications from contracted, non-delegated MCOs and ensures that applications are completed and submitted to MCOs to ensure

   medical and dental provider participation.

*  Provides Malpractice Insurance & License updates and re-credentialing information to all non-delegated MCOs on a regular basis

*  Researches provider issues and responds to MCO requests via mail, e-mail, or verbally, in a timely manner, as required.

*  Creates credentialing packets for new providers and assists in filling out information where needed.

*  Enters initial information and performs provider licensure updates in the CAQH on-line credentialing database.

*  Completes and submits individual provider agreements to MCOs as necessary.

*  Performs reimbursement analyses of provider claims as required.

*  Participates in regularly scheduled MCO payor meetings.


Position Requirements

* This position requires a minimum formal education of HS Diploma and a minimum of 2 years job-related experience.

Associate’s Degree or Bachelor’s Degree preferred.

* Strong Managed care experience may substitute for degree Proficiency in MS Office, Word, Excel and Outlook required; MS Access a plus.

*  Excellent verbal and  written communication.


* CPCS Certification. 

Strong organizational skills and attention to detail with the ability to handle multiple tasks.


*  Knowledge of managed health care terms and practicesExperience in a managed care operations setting preferred



 Please contact:

Person/Phone ContactBrunilda Fredjaj, Human Resources Generalist
Position Available

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