Managed Care Associate

Overview Managed Care Associate is responsible for coordinating all Managed Care Physicians credentialing & enrollment with respective Manage Care Payers. This position is also the key individual who collaborates with payers responsible for communicating with Dept. Manager on the status and requirements for physicians enrollment. Liaison for health plans and internal departments to resolve credentialing inquiries. Maintain an accurate Access database with providers credentialing status. All applications and programs on all computers (MSL, Adobe Pro 8, Excel ,Access , CAQH). Responsibilities

• Establish and maintain positive relationships with patients, visitors, and other employees. Interacts professionally, courteously, and appropriately with patients, visitors and other employees. Behaves in a manner consistent with maintaining and furthering a positive public perception of BronxCare Health System and its employee.
• Contributes to and participates in the Performance/Quality Improvement activities of the assigned department.

Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the BronxCare Health System(a) Safety and Security Policies, (b)

Risk Management:

Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service.

• Enrolling all providers in assigned contracted health plans. Submits all updates, changes and terminations to assigned payers via monthly delegates excel spreadsheet submissions. Provides support for all payers,
• Maintenance of database for providers PAR vs NON PAR status. Database upgrades as necessary. As well as various other provider data that requires periodic review/updating.
• Assists in customer service for the department's phone line for internal and external managed care inquires.
• Uploading (or manual entry) of newly received provider IDs and effective dates from plans in the database.
• CAQH implementation and quarterly updates for providers
• Assists in creating/completing provider Medicaid maintenance forms for distribution and collection
• Basic office functions, copying, scanning, filing and mailroom pick up and mail sort and provider document pick up. Qualifications
• Prior experience with the Managed Care credentialing process.
• Knowledge of NCQA standards and requirement and Managed Care credentialling policy and procedures. Great communication skills required and working knowledge of Managed Care credentialling/enrollment. 3-5 years experience in related areas.
• High School or GED
• Associate's
• Prior experience with access database, excel; CAQH application process;