Managed Care Liaison na JCCA

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