Managed Care Coordinator (Project Management)

General Purpose

The Specialist/Coordinator is responsible for maintaining contracting platforms internally and externally for PACS affiliated facilities. Directly supports the Managed Care Department by completing Health Plan applications, submitting credentialing documents, notifying facilities on contracts and providing education on accessing contracts.

Job Essentials

Credentialing:

• Responsible for maintaining credentialing status of Skilled Nursing Facilities with Health Plans by submitting credentialing applications and required documentation timely.

• Maintains shared drive that houses all facility credentials and licenses. Performs regular audits of certifications and updates Health Plans accordingly to ensure compliance.

• Assists Managed Care Department with the Health Plan contracting process, from credentialing, proper filing/loading of contracts, and notifying facility.

• Registers and renews facilities with SAM.gov, maintains an intricate data record to track registration and status.

MNS:

• Maintain Facility profiles and documents in Credentialing Point.

• Assist with setting up MNS training with facilities for authorization and claims access.

• Coordinate with MNS on loading new or revised credentialing documents.

• Complete Health Plan Credentialing documents in Credentialing Point.

Contracting support.

All other duties as assigned.