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Managed Care Liaison bei JCCA

JCCA · Pleasantville, Vereinigte Staaten Von Amerika · Onsite

56.160,00 $  -  62.400,00 $

Jetzt bewerben

Position Summary:

The Managed Care Liaison will coordinate with the Managed Care Organizations (MCO) to support program initiatives and ensure financial viability. Primary role is to ensure that there is a highly-coordinated approach between JCCA, Human Resources Administration (HRA), Local Department of Social Services (LDSS), Administration for Children’s Services (ACS), and the Managed Care Organization.

Responsibilities:

  • Verify and monitor clients Medicaid eligibility and enrollment history through various channels, including ePACES and Health Plans systems.
  • Monitor Medicaid re-certification timeframes for each active client.
  • Submit documentation to support medical necessity for ongoing services.
  • Comply with HIPAA guidelines and maintain confidentiality of member, provider, medical and departmental information. Adhere to state and federal compliance and regulatory guidelines.
  • Submit timely notification of clients currently receiving services (i.e. Health Home, Children Family Treatment Support Services, evaluations and Primary Care) to managed care plans.
  • Work collaboratively with Billing and programs to resolve claims denials and file appeals and grievances requests with the health plans.
  • Obtain and monitor ongoing concurrent authorization for services, document in EHR and notify program lead.
  • Coordinate with the MCO foster care liaison/coordinator.
  • Inform and coordinate with the MCO’s when a child’s primary care provider needs to be changed.
  • Serve as primary contact person with the MCO to assist with the following:
  • Immediate issuance of a Welcome Letter
  • Securing identification showing the effective date (including immediate temporary identification)
  • Replacement insurance identification card
  • Assist with foster care changes and access to health care
  • Coordinate single case agreements when a child is receiving services outside of service area.
  • Coordinate referrals for services with health care providers and assist in provider selection.
  • Maintain eligibility for public insurance.
  • Submit client’s treatment plan/or Health Home plan of care to MCO.
  • Liaison with Local Department of Social Services (LDSS) and Administration for Children Services (ACS) to ensure clients’ maintain appropriate eligibility status.
  • Perform other job – related duties as directed.

Qualifications:

MINIMUM REQUIREMENTS

  • Bachelor’s degree.
  • Experience in Medicaid Managed Care.
  • 3 years overall experience.
  • Experience with Medicaid eligibility.
  • Experience exercising independent thinking, problem solving and achieving goals.
  • Proficient in Microsoft Excel (formatting formulas, managing data, and filtering results), and Access (running queries, Macros and building tables for reporting purposes).
  • Based on business needs, must be able to travel across New York City and Westchester County. 

PREFERRED REQUIREMENTS

  • Experience working in child welfare or related system.
  • Experience with claims processing, provider billing and provider relation.
  • Experience in care coordination.
  • Strong interpersonal skills – ability to build relationships and trust and understand personal and professional boundaries.
  • Experience working in a community-based healthcare setting for at least 3-5 years preferred.
  • Knowledge of Managed Care Organizations utilization management, and claims processing procedures.

Pay Rate: $27 -$30

 

Jetzt bewerben

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