Business Office Coordinator Network Contracts

Mount Sinai Medical Center•Hialeah, FL

24d

About The Position

Responsible for Medicare Part D, required compliance plan activities, claims processing, plan payments, provider/vendor health plan network, track current contracted and employed staff assignments and credentials and health plan enrollment and disenrollment activities.

Requirements

Bachelors Degree is preferred.
At least 2 years prior experience in a health care business office.

Nice To Haves

Certifications in medical coding or medical records helpful.
Prior experience in health plan claims processing extremely helpful and health plan auditing experience helpful.
Experience in health plan credentialing, contracting, accounts payable, and/or related business office functions preferred.

Responsibilities

Serves as the point person for TPA accountability for Eldercare including claims processing, payments and reporting's and keeps the Executive Director informed.
Responsible for the weekly PreCheck and Pend Report including accuracy and follow up in the required time frame.
Audits claims to be paid for accuracy to ensure Eldercare is paying the correct rate.
Tracks claims for timeliness and follows up with TPA as needed and reports claims not paid timely
Reviews claims to ensure billing requirements are met, monitor trends and identify opportunities for improvement.
Review denied, suspended and other claim status reports to identify errors for correction or notify provider/vendor of issue.
Reviews and tracks Appeals.
Notifies Manager of appeals received and approval needs.
Reviews monthly payments received for accuracy.
Follows up on all short or nonpayment's within 5 days of receipt and notifies Manager of outstanding payments.
Oversees Medicare and Medicaid payments, identifies any short or missed payments and follows up with payer.
Keeps Executive Director notified of status.
Responsible for the credentialing (per Managed Care/PACE guidelines) of all providers that do not have MSMC privileges.
Oversees the provider network for Eldercare including new and existing providers
Serves as the liaison between Eldercare and all of the contracted providers in the network
Serves as the liaison between MSMC Managed Care and Eldercare to resolve credentialing issues.
Identifies providers needed in the network and proactively starts the contracting and credentialing process.
Maintains the data base for credentialing items (licenses, insurance certificates and other required items) and ensures they are always current.
Maintains Network Provider Contract Database and updates timely and accurately
Monitors Network Providers and vendors contracts for renewal/expiration and follow up to ensure the contract remains active.
Keep Executive Director updated on contracts status.
Coordinates orientation and annual required updates for all Network Providers
Completes a Letter of Agreement and gathers the required credentials when needed for a provider outside of the Eldercare network
Responsible for all Eldercare Accounts Payable including accurately completing the check request and attaches the invoices for management approval.
Maintains a roster of all prospects and active participants Medicare and Medicaid number and status.
Leads the enrollment process, by enrolling the prospects, preparing the required reports and communication with the team.
Communicates with management regularly to keep them abreast of ongoing projects/issues
Completes assignments in an accurate and timely manner.
Know and adhere to philosophy and goals of Eldercare.
Assists with Eldercare regulatory and license renewals, including W9 and insurance certificate requests from vendors.
Participate in and support Quality Improvement initiatives