Managed Care Coordinator (Contract)
About The Position
Fabric is looking for a Managed Care Coordinator to join us on a contract basis and serve as a critical link between our clinical teams, healthcare payers, and finance department. In this role, you will own the end-to-end provider enrollment and credentialing process while supporting claims management and denial resolution — ensuring our providers are properly networked and that revenue flows without unnecessary delays. This is a detail-oriented, process-driven role that sits at the heart of our revenue cycle operations. You will be the go-to person for payer relationships, provider data accuracy, and compliance documentation — playing a direct role in keeping our clinical and financial operations running smoothly.
Requirements
- 1–3 years of experience in provider credentialing, enrollment, or managed care, preferably within a hospital or insurance setting.
- Demonstrated proficiency with payer portals such as Availity, PECOS, and eMedNY, and experience with credentialing software.
- Solid understanding of medical billing, coding, and claims adjudication processes.
- Strong analytical and critical thinking skills, with the ability to resolve complex enrollment issues under time pressure.
- Excellent written and verbal communication skills.
- High school diploma or GED required; Bachelor's degree preferred.
Nice To Haves
- Preferred certifications: CPCS, CPMSM, CPB, CBCS, and/or CMRS.
- Prior experience with virtual care platforms is a plus.
Responsibilities
- Managing the complete provider enrollment and re-credentialing process with all relevant payers, including Medicare and Medicaid, and maintaining up-to-date CAQH profiles and TIN information.
- Overseeing the claims queue, analyzing denied claims and underpayments, and resolving issues in a timely manner.
- Maintaining meticulous accuracy of provider data — including NPIs, tax IDs, professional licenses, and addresses — across internal and payer-specific databases.
- Ensuring all MCO compliance documentation and provider data meet regulatory standards set by bodies such as NCQA and URAC.
- Serving as the primary point of contact with healthcare payers on network participation status, enrollment, and reimbursement inquiries.
- Identifying and reporting on trends in claim denials and outstanding A/R balances to support ongoing improvements in revenue cycle efficiency.
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What This Job Offers
Career Level
Entry Level
Education Level
High school or GED
