Managed Care Contracting Administrator - New Paltz Family Health Center

SUMMARY:

This position will provide support to the Department of Business Development in the area of Insurance

Contracting and Contract Maintenance. Key areas of focus will include research projects, health center

enrollments, liaison with payers, analysis, follow-up and implementation/communication of Medical, Dental, and

Behavioral Health Contracts. In addition, this position will support the business development activities. They

shall work with all sites and departments of the Institute.

ESSENTIAL JOB DUTIES

Clinical/Technical/Service

• Demonstrates the ability to perform technical/service/administrative tasks as applicable to position
• Initiate, review, and distribute a wide range of contractual documents and agreements
• Maintain databases for all contracting and credentialing activities for audits to include but not limited

to; contract tracking and changes, payer contacts, payer terms, NPI/MMIS/PTAN

• Review and support the execution activities of contracts including addendums, comparison of fee

schedules and perform payer analysis

• Create monthly health plan report cards to assist in payer analysis of new and current contracts
• Ensure timely communication of all new contracts and updated contracts through education/training,

notifications, and practice management builds.

• Credential all new sites with Medicare, Medicaid and managed care payers. Maintain recertification

and all-encompassing functions across all sites

• Reconciliations for payers which may include reconciling data for Institute programs/certifications

such as PCMH

• Project Management Activities shall include but not be limited to the following: Research ability to

provide and be reimbursed for new service initiatives

• Research new CPT codes and initiatives with managed care payers and CMS for reimbursement and

analyze business impact

• Develop and create strong relationships with Managed Care Payers
• Work with Payer Analyst on Managed Care Payer Reimbursement to Contract
• Handles Payer and Patient Complaints
• Attends meetings and participates in committees/conferences as assigned and reports on major points and actions to resolve or to be taken

Prepare various documents and handles confidential matters in accordance with Institute rules and procedures

Helps to compile financial, statistical data, and reports as assigned.

Maintains strictest confidentiality

Participates in professional development activities to keep current with healthcare trends and practices.

Participates in the development of other staff members

Meets regulatory, licensure, and annual health assessment requirements

Identifies learning strengths and needs

Utilizes learning strengths and needs

Utilizes learning resources D. Communication/Relationships

Demonstrates a professional, courteous, and respectful attitude in dealing with patients, families, and significant others

Displays courtesy, tact, and patience during interactions with all members of the hospital staff and extended community Demonstrates a professional, courteous, and respectful attitude in dealing with clinical practice staff

Shall perform other duties/projects as assigned

EDUCATION:

Associate degree in finance, business, healthcare, management or related field

• or 5 years' experience -Required

Bachelor's degree in finance, business, healthcare, management or related

field - Preferred

WORK EXPERIENCE:

Insurance Contracting - Required

Working in an Article 28 and/or Federally Qualified Health Center system. - Preferred

COMPUTER PROFICIENCY:

Proficiency with Computer functions/programs; billing/data software,

Microsoft applications (Windows, Word, Excel, Outlook