Managed Care Coordinator - EFT and Bank Migration/Payer Credentialing (Remote)

JOB TITLE : Managed Care Coordinator - EFT and Bank Migration / Payer Credentialing (Remote)

GENERAL SUMMARY OF DUTIES : Works with and supports Managed Care, Revenue Cycle, Finance, Treasury and both internal and external customers in various regions to execute tasks related to new payer enrollments for electronic funds transfer (EFT) and bank account consolidation and EFT migrations.

Works with and supports the Managed Care Department in all aspects of initial credentialing and re-credentialing of ASCs with various Payor Plans, Government Agencies and State Agencies.

Processes and monitors initial and renewal applications for ASCs / facilities. Communicates with ASCs, Contract Managers and Regional Directors of Managed Care regarding payer application processing, the collection of all required documentation;

submission to payers and assists with credentialing document routing and filing.

• Maintains accurate, organized, and current files and databases; documents all work efforts in department’s task workflow system;
• assists when needed in audits performed by regulatory and accrediting agencies, Department of Health, managed care organizations / payers, and others;

and functions as managed care liaison, advisor and resource person for ASC administrators, business office staff, and other leadership personnel.

ESSENTIAL FUNCTIONS : EFT Enrollment and Bank Migration

• Assist to ensure current and acquired facilities enroll in electronic payment technology offered by managed care payors
• Execute tasks related to ensuring payer EFT deposits are coming into the proper bank accounts
• Review EFT enrollment forms for completeness and appropriate approval and signatures
• Maintain shared drive folders with accurate record keeping of bank migration projects- i.e. tracking spreadsheets and payer confirmations
• Assist to maintain accurate records as it relates to bank account letters and W-9 forms
• Answer questions and process requests from Revenue Cycle / Finance / Treasury teams regarding EFT transactions and bank accounts
• Collaborate with ASC local business offices regarding EFT enrollment activities
• Provide notification to applicable internal customers regarding completion of deposit migration and timing of when to close bank accounts
• Assists to resolve managed care operational issues related to EFT enrollments
• Correspond with various managed care payors to ensure proper management of EFT enrollments and changes of bank information
• Participate in the implementation of new ASCs assisting with the onboarding of payers for the first time
• Function as managed care liaison and resource person for orienting new ASC administrators, business office staff, and other leadership personnel
• Participate in meetings related to new EFT enrollments and bank migration projects
• Other assigned duties as required

ESSENTIAL FUNCTIONS : Payer Credentialing

• Process initial and re-credentialing ASC payer applications for Commercial and Medicaid / Medicare replacement payers
• Assist with State Medicaid and other govt. payer enrollment applications as requested
• Correspond with ASC administrators, business office teams and contract team (Contract Managers and Regional Directors of Managed Care) regarding credentialing needs, status of provider files, or any other questions that arise.

Notifies teams when actions are completed.

• Maintain shared drive folders with accurate record keeping of payer application documents and ASC certifications, accreditations, licenses, etc.
• Sends organization ownership forms to payors as requested
• Assist with payer credentialing audits and verification of payer participation statuses
• Assist with quarterly payer data validation requests
• Assist with payer notifications regarding facility demographics changes
• Other assigned duties as required

EDUCATION / EXPERIENCE :

• 3-5 years of experience in managed care environment (with either payer or provider)
• Bachelor's degree in healthcare and / or business preferred
• Experience in payer EFT / ERA enrollments strongly preferred
• Experience in the completion of payer facility credentialing applications and an understanding of required facility credentials / licenses strongly preferred

KNOWLEDGE :

• Knowledge of Managed Care payers and products; Government and various state payers DOL, WC, Champ VA, Tricare, etc. included
• Knowledge of the various payer portal platforms to complete EFT enrollments i.e. major commercial payers, Availity, Optum, Payspan, Zelis, ECHO, Instamed, Change Healthcare, etc.
• Knowledge of Revenue Cycle operations as it applies to managing EFT / ERA transactions and information
• Knowledge of clearing house vendors i.e. Waystar
• Knowledge of computer systems and spreadsheet applications
• Knowledge of managed care insurance policies and procedures
• Knowledge of state, federal and accreditation board regulations

SKILLS :

• Microsoft Excel skills required knowledge of spreadsheet formatting
• Analytical thinking and problem-solving skills
• Skilled in outbound calls for follow-up and problem resolution- phone soft skills a must
• Skilled in gathering and reporting credentialing / certification information.
• Skilled in written and verbal communication and customer relations
• Skilled in working with Windows based software systems
• Skilled in the use of various PDF editor applications - Adobe Reader or PDF XChange
• Skilled in Intermediate Microsoft Word Proficiency in Microsoft Office such as Word, Outlook, and PowerPoint

ABILITIES :

• Attention to detail and organization a must
• Ability to communicate professionally and effectively a must and work effectively with internal and external customers
• Ability to maintain strict confidentiality with demonstrated experience applying good judgment and discretion
• Ability to identify, analyze and solve credentialing problems
• Ability to handle multiple tasks / projects and reach varied deadlines
• Ability to serve as a resource person, resolve administrative problems, and exercise sound judgment in decision-making
• Excellent time management skills
• Exceptional ability to plan, organize, and implement a plan to completion.
• Ability to prioritize duties and be self-motivated
• Ability to work with multiple excel spreadsheets

PHYSICAL / MENTAL DEMANDS : Requires sitting and standing associated with a normal office environment.

ENVIRONMENTAL / WORKING CONDITIONS : Remote position; work from home. Normal busy office environment with email, phone, data entry, and spreadsheet work.

Occasional evening or weekend work may be required for special projects. Possible out of state travel for department meetings 1 time per year.