Managed Care Manager

FacilityWyckoff Heights Medical Center
DepartmentFaculty Practice
CategoryFull Time
Descriptionassist and serve as a liaison between the Managed Care/Provider Enrollment Department, various Insurance Carriers to enroll Providers into various participating plan.perform all duties providing superior patient care and promoting good guest relations.
Job Details


* 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 audits.

   *  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

 Formal Education This position requires a minimum formal education of an Associate’s Degree or equivalent and

 Job-Related minimum of 3 year job-related experience.

 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.

 License, Registration, or   Cert. Required CPCS or CPMSM certification required or 3 years experience in a credentials or managed care setting with certification obtained within 5 years.

Comments     Self-starter and self-motivated, functions independently with minimal direction. Maintain  professional demeanor and confidentiality. Flexible, team player. Must be able to work with a variety of people and circumstances.

Person/Phone or
Position Available2018-05-02 10:50:55

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