Managed Care Coordinator
New York Oncology Hematology•Clifton Park, NY
About The Position
The Managed Care Coordinator supports provider credentialing and enrollment, managed care contracting, Stem Cell Transplant and CAR-T program payer requirements, and coding and medical record review activities. The role maintains provider and payer information, monitors applications and contract activity, and coordinates with internal teams and payers to support network participation and reimbursement.
Responsibilities
- Maintain provider rosters and submit updates to payers monthly or when provider changes occur.
- Coordinate enrollment and credentialing for newly hired physicians and advanced practice providers.
- Prioritize Medicaid credentialing and recredentialing to support timely payer participation and minimize reimbursement disruptions.
- Prepare and submit credentialing applications for commercial, Medicare Advantage, Medicaid Managed Care, and other third-party payers.
- Monitor application status and follow up with payers about pending credentialing requests.
- Maintain provider demographic information in payer databases and internal systems.
- Track recredentialing requirements and ensure required documentation is submitted on time.
- Assist with CAQH maintenance and provider attestations.
- Assist with managed care contract implementation and maintenance.
- Maintain managed care contract libraries and related documentation.
- Track contract amendments, fee schedules, participation status, and renewal dates.
- Support payer outreach regarding contracting inquiries and provider network participation.
- Prepare reports on payer participation, credentialing status, and contract activity.
- Assist with special projects related to reimbursement, network expansion, and payer initiatives.
- Verify payer participation and eligibility requirements for Stem Cell Transplant and CAR-T Therapy services.
- Track network participation requirements and payer-specific transplant program approvals.
- Maintain records of Letters of Agreement (LOAs), Single Case Agreements (SCAs), and transplant network contracts.
- Monitor contract expiration dates and assist with renewals.
- Coordinate with clinical, financial clearance, and contracting teams regarding payer requirements and network status.
- Assist with payer coding research and reimbursement policy reviews.
- Track coding-related denials and reimbursement trends.
Benefits
- Professional growth and continuing education opportunities
- Collaborative team environment
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
