Location: MAITLAND, FL, United States
Zip Code: 32751
Job ID: 385
Description
Job Summary:
The Managed Care Coordinator is responsible for overseeing the provider credentialing and enrollment process, ensuring compliance with managed care organizations (MCOs), and assisting with the resolution of claim and authorization issues. This role involves communication and collaboration with internal teams and external stakeholders to ensure timely and accurate provider enrollment, maintaining up-to-date records, and by supporting the negotiation of reimbursement rates. The position also requires proactive management of re-credentialing of providers and centers to ensure continuous participation in health plans. The ideal candidate will have a strong understanding of healthcare insurance processes and be detail-oriented in maintaining accurate provider files and facilitating effective relationships with payors.
Key Responsibilities:
Qualifications:
Education & Experience:
Skills & Knowledge:
Work Environment:
Supervisory Responsibilities:
(Scope of the person’s authority, including a list of jobs that report to this job).
Essential Qualifications:
(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the competencies (minimum knowledge, skill, and ability) required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions).
Education/Licensure/Certification:
This position requires a Bachelor's degree in business or related field.
Required Knowledge:
The candidate has 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. Must be familiar with computers, medical terminology, ICD-10 and CPT coding, and modifiers.
Experience Required:
This position requires a minimum of 3-5 years experience in either the payer or provider environment. Demonstrated ability in resolving complex issues is required. Experience with behavioral healthcare organizations are a plus.
Skill and Ability:
The candidate has the ability to work collaboratively with colleagues. Represent the company in a professional manner. Strong organizational skills with a keen ability to prioritize and multitask. Ability to adhere to and meet deadlines. Good communicator (oral and written). Strong administrative and data management skills. Ability to raise issues proactively and in a timely manner. Strong presentation skills Ability to work with software systems.
Physical Demands/Work Environment:
(The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)
Core Competencies:
Mental Activities:
(The mental activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)
Reasoning Ability:
Ability to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. Ability to maintain patient and treatment confidentiality.
Mathematics Ability:
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, and volume.
Language Ability:
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, and governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from fellow employees and managers.