Managed care contracting jobs in Mount Vernon, New YorkCreate job alerts

Job Description Job Overview of Billing & Medicaid Managed Care Liaison The Billing and Medicaid Managed Care Liaison is responsible for the coordination of the billing and claiming process for the Office of Mental Health - Article 31 and, Children and Family Treatment Support Services (CFTSS), Office of Addiction Services and Supports - Article 32, and the Department of Health - Article 29i services. The Billing and Medicaid Managed Care Liaison directly ensures the coordination of health services for children enrolled in Article 29I and works collaboratively with Directors and Supervisors to support coordination of care in other programs. The Billing and Medicaid Managed Care Liaison makes sure Medicaid and Managed Care is verified for CFTSS & Article 29-I and checks eligibility for Committee on Special Education (CSE) placed youth and clinic clients. The Billing and Medicaid Managed Care Liaison confirms contract compliance and credentialing with insurance companies, including Single Case Agreements. The Billing and Medicaid Managed Care Liaison reports on collections and revenue as appropriate, maximizes revenue pertinent to enhance cash flow, ensures contract compliance and credentialing with insurance companies, and acts as a primary liaison with managed care organizations, program staff, and billing entities to ensure compliance and accuracy. The Billing and Medicaid Managed Care Liaison attends internal and external planning and status meetings as needed and provides exemplary customer service and presents a professional image. Essential Duties of Billing & Medicaid Managed Care Liaison Key duties of this position include, but are not limited to, the following: • Serves as the liaison between finance and billing vendor and as the primary contact person for Medicare and Medicaid managed care and insurance companies., • Coordinates health care services and benefits w/ 29-I treatment team, MMCP's foster care liaison, Local Department of Social Services’ managed care foster care liaison, health care providers, & school and community-based services, • Interacts with clinical and billing staff and checks eligibility for public or private health insurance for CSE children and supports with checking eligibility for clinic clients as needed., • Manage the billing process, voids, adjustment and collections as needed, reports weekly according to procedures to determine source, reasons, and resolution, and ensure issues are addressed in a timely manner., • Assists with foster care placement changes, court-ordered services, and fair hearings for youth in Foster Care., • Maintain up to date knowledge of billing regulations/requirements of Commercial insurance, Medicaid, Medicare, and Medicaid Managed Care pay sources and payor contract documents., • Verifies that insurance company contracts, including changes to contracted services, are maintained and re-credentialed., • Responsible for the closing and running of financial reports as appropriate, and ad-hoc reporting as needed., • Maintains knowledge of OMH, OCFS, DOH, and OASAS regulations as well as agency policy and procedures and developments as they relate to administrative practice., • Supports overall strategic plan for the organization., • Ability to adhere to organization’s core values and commitments. Essential Qualifications of Billing & Medicaid Managed Care Liaison Key qualifications include: • A Bachelor’s degree in Business, Finance or a related field with 3 years’ experience OR an Associate’s degree in Business, Finance or a related field with 5 years’ experience in a medical billing setting or High School or GED with 7 years of experience., • Familiarity with Article 31, 32, 29i and CFTSS billing, • Working knowledge of Medicaid, Managed Care and Insurance policies and operations, including claim processing, contracting & Single Case Agreements., • Comprehensive knowledge of EMR billing systems required., • Strong customer service skills required., • Excel skills, ability to work well with people, and manage priorities and deadlines required., • Ability to access and utilize ADP app on smartphone or other device for access to agency programs. Benefits of Billing & Medicaid Managed Care Liaison • Generous PTO, 4 weeks of vacation, floating holidays, holidays, personal and sick time, • Health Insurance, • Dental Insurance, • Vision Benefits, • 401(k) Employer Contributions, • Tuition Reimbursement, • Flex Spending Accounts, • Employer Paid STD, LTD and Life Insurance, • Professional Development Physical/Travel Requirements Must have ability to reach, walk, sit, climb stairs, bend, lift, and be able to travel. Drivers preferred. required. The employee must be able to meet these requirements with or without a reasonable accommodation. Disclaimer Nothing in this job description restricts Andrus’ right to modify the duties/responsibilities of this job at any time, with or without advanced notice. EEO Statement Andrus is an equal opportunity employer.

ICD coding accuracy, payer policy interpretation, managed care utilization review)\n \n- Provide structured feedback on AI accuracy in areas such as federal and state insurance regulations (ACA, ERISA, HIPAA, CMS guidelines), payer contracting, and industry-specific terminology\n \n- Collaborate asy

The Regulatory Affairs Director is responsible for leading activities of the Regulatory Affairs Department, including contracts, compliance, surveys, audits, investigations, reporting, plan development and renewal, credentialing, Fraud, Waste & Abuse Special Investigations, provider network and relations, regulatory updates and compliance matters. Essential Functions: • Review, draft, negotiate and process agreements and amendments in accordance with organization guidelines., • Lead projects involving the collection and submission of data and information related to government audits, surveys and requests., • Oversee provider contracting, including letters of agreement and associated follow-up., • Review, disseminate and handle fair hearing (FH) notices and decisions; manage FH calendar; attend FHs as needed, review and handle communications with OTDA and submit reports; prepare status reports and updates on cases., • Lead activities of the Special Investigation Unit (SIU), including SIU reporting and internal investigations., • Review and update applicable HIPAA policies and procedures in compliance with HIPAA laws and regulations., • Review OIG/OMIG requirements and best practices for compliance and program integrity; review and update compliance materials, including manuals, policies and procedures, and handbooks, to comply with regulatory requirements., • Make recommendations based on best practices and draft policies and procedures., • Review DOH and CMS plan contracts and edit plan documents in compliance with contract requirements., • Review, clarify and disseminate CMS memos and DOH guidance; keep abreast of related laws, regulations and official guidance., • Coordinate document and requests of outside counsel for litigation matters., • Oversee provider credentialing process and related activities., • Draft policies, procedures, manuals, plan and member materials., • Provide guidance and direction to Department staff., • Perform any other job related duties as requested. Education and Experience: • Juris Doctor (J.D) degree from an accredited college/university required, • Five (5) years experience with Medicare and NY Medicaid managed care contracting and compliance required, • Previous leadership experience preferred Competencies, Knowledge and Skills: • Strong customer service and team orientation, • Ability to adapt to a changing environment to achieve results, • Demonstrated leadership skills, • Skilled in organization, workflow analyses and management of details, • Advanced Microsoft Office skills, including Word, • Strong editing and proofreading skills, • Excellent written and oral communications skills, • Excellent time/project management and prioritization skills, • Ability to excel in fluid, dynamic environment Licensure and Certification: • Current, unrestricted Attorney license required Working Conditions: • General office environment; may be required to sit or stand for extended periods of time, • Ability to travel as required by the needs of the department., • 2 Days work from home; 3 days work in Bronx office each week Compensation Range: $135,600.00 - $237,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies: • Fostering a Collaborative Workplace Culture, • Cultivate Partnerships, • Develop Self and Others, • Drive Execution, • Influence Others, • Pursue Personal Excellence, • Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.