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Job Offer: Managed Care Coordinator:Job description:
Managed Care CoordinatorPOSITION OVERVIEWPOSITION SUMMARYthis job offer will supervise the creation, implementation, and provision of the managed care billing for the Residential and Foster Care division. this job offer will be the point person for managed care companies, finance, and program within the function of Medicaid billed services. this job offer will supervise the divisions Medicaid liaisons (Managed Care Liaisons) whose function is to review and verify Medicaid enrollment and eligibility, monitor accuracy of documentation for the division for Medicaid per diems, authorizations for referrals, and support of CFTSS services and HCBS respite. ESSENTIAL tasks AND RESPONSIBILITIES include the following. Other tasks may be assigned. Employees are expected to be awake and alert while working. » Create, implement and monitor procedures for the division involving enrollment, eligibility and billing of managed care companies. » Hire, train and supervise Managed Care liaisons » Functional division point of communication between finance, division programmatic administrators, medical and clinical managers, and managed care companies. » Maintain expert expertise on the function of liaisons, and be able to step into function if needed. » Maintain expertise and function as a resource for the division on Medicaid managed care policies and procedures (both for the Managed Care plans and the 29 I Health Facility policies). » Partner with clinical leads in the agency in expanding Medicaid services provided in the system and create and maintain a system of oversight and quality assurance for billing. » Must possess expertise of billing needs for different services including core health services, other licensed health providers, and the CFTSS and HCBS services the division offers. managerY RESPONSIBILITIES Sets the pace of work for the group and shows other workers in the group how to execute assigned tasks. May train and provide feedback on tasks. Generally performs the same work as the group, in addition to lead tasks. May review work of external providers. leadership abilities Supervises/supervises work through the planning and scheduling of work and the review and approval of tasks. SUPERVISION RECEIVED Direction: receives guidance with respect to general objectives; in the majority of tasks and projects assigned, determine methods, work sequence, scheduling, and how to achieve Position Description Managed Care Coordinator objectives of assignments; operate within specific policy guidelines. May require approval before proceeding with next steps. QUALIFICATIONS to execute this job prosperously, an individual must be able to execute each essential duty satisfactorily. The requirements listed below are representative of the expertise, skill, and/or capability required. Reasonable accommodations may be made to enable individuals with disabilities to execute the essential functions. EDUCATION and/or practice Requires Bachelors Degree with a minimum of three to four years related practice CERTIFICATION / LICENSURE None expertise Broad expertise of a discipline such as social work, teaching, behavioral science, finance, information technology, or business administration; involving the use of a broad theoretical expertise. COMMUNICATION and CONTACT with OTHERS Requires effective communication expertise. Communication involves frequent contacts with clients/families, other departments, and individuals in administrative or managerial positions, communicating on information and non-controversial problems within and outside the organization and presenting information and recommendations for solutions. Represents the organization in routine public activities such as making client-related simple presentations or providing information. Interpersonal communication at this level requires effective communication expertise to obtain cooperation or share/receive information which will contribute to decision making. DECISION MAKING Work is primarily performed independently on professional, technical, or administrative functions. Makes decisions within scope of position responsibilities; may receive guidance in planning work and/or defining objectives. CONSEQUENCES of ERRORS Embarrassment or Financial Loss: Errors resulting from decisions which are not subject to review might be detrimental to clients, disrupt services, cause moderate financial loss, embarrass the organization, or disrupt operations. Errors may cause friction with or loss of client advocates, clients, may alienate distributors, vendors, or obligate the organization to accept moderate financial obligation/risk or loss of revenues. LANGUAGE expertise capability to read, analyze, and interpret technical or scientific journals, financial reports, and legal documents. capability to respond to inquiries or complaints from customers, regulatory agencies, or members of the business community. capability to write speeches and articles for publication that conforms to prescribed style and format. capability to effectively present information to top management, public groups, and/or boards of directors. Position Description Managed Care Coordinator REASONING capability capability to define problems, collect data, establish facts, and draw valid conclusions. capability to interpret an broad variety of technical information in written, mathematical or diagram form and deal with several abstract and concrete variables. ORGANIZATIONAL SCOPE and IMPACT this job offer is not a functional head of a program or department. FINANCIAL MANAGEMENT RESPONSIBILITY Responsible for limited financial transactions. May be responsible for petty cash, flex funds, or similar types of financial transactions. MATHEMATICAL expertise capability to calculate figures and amounts such as discounts, interest, overtime, proportions, percentages. capability to apply concepts of basic algebra. capability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. TECHNOLOGY expertise Proficient computer expertise including Windows operating environment using MS Office applications. Demonstrated use of intermediate computer operations (basic programming, relational databases, and operating systems) and intermediate software packages, (word processing, spreadsheet, graphics, etc.). WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Work requires occasional travel to alternate work locations. Exposed to adverse or awkward working conditions caused by such things as extreme heat or cold, other outdoor elements, poor air circulation, etc. Direct care of clients; required to execute Therapeutic Crisis Intervention techniques. Possible exposure to blood borne pathogens. Possible exposure to verbal and/or physical aggression. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to prosperously perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to execute the essential functions. Some physical exertion is required such as long periods of standing, recurring bending and lifting, and/or lifting of items up to 35 pounds and/or may be required to execute physical interventions. ABOUT NORTHERN RIVERSSkills:
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