Medicaid Managed Care Liaison

Job Type

Full Time

Published

08/31/2018

Address

Bronx
New York
United States

Description

SUMMARY OF RESPONSIBILITIES: Under the supervision of the Chief Financial Officer (CFO) and in cooperation with all other agency personnel, Managed Care Liaison will coordinate with the Medicaid Managed Care Plans (MMCPs). Primarily role is to ensure that there is a highly-coordinated approach between LDSS, the VFCA, and the Medicaid Managed Care Plans.

 

FUNCTIONS:


  • Coordinate with the MMCP’s foster care liaison/coordinator
  • Inform and coordinate with the MMCP when a child’s primary care provider needs to be changed
  • Primary contact person for the MMCP to assist with the following:
  • MMCP enrollment, disenrollment, and transitions
  • Immediate issuance of a Welcome Letter
  • Securing identification showing the effective enrollment date (including immediate temporary identification)
  • Replacement insurance identification card
  • Assist with foster care placement changes including:
  • Access to health care
  • Facilitate a single case agreement when a child is placed outside of the MMCP’s service area or provider network
  • Interact with clinical and billing staff
  • Refer children for needed services and assist in provider selection
  • Coordinate with health care providers, including school- and community-based services
  • Maintain eligibility for public or private health insurance
  • Coordinate benefits
  • Assist with consent and/or confidentiality issues
  • Oversee all business functions
  • Assist with court-ordered services and fair hearings
  • Attend required training.
  • Read required books.
  • Responsible for complying with rules and regulations governing access to Protected Health Information under HIPAA. Access protected Health Information is limited to the extent required to perform responsibilities herein, dictate the level of access, use, and disclosure of confidential information.
  • Perform other duties as requested by your immediate supervisor or the Chief Executive Officer


Required Experience:


  • Bachelor’s degree required, Master’s degree preferred
  • Experience in managed Medicaid contracting and networking required
  • Knowledge of provider contracts/reimbursement interpretation preferred
  • Experience, Expertise, and Knowledge of the child welfare system, foster care healthcare requirements, the unique complex needs of foster care population, and Medicaid Managed Care policies and operations
  • Experience with claims processing, provider billing and provider relations preferred
  • Ability to clearly communication both in writing and verbally
  • Proficient in Microsoft Office
  • Ability to maintain and uphold professional boundaries
  • Ability to handle confidential material in a responsible manner
  • Valid NYS Driver’s License required
  • Ability to travel to all agency locations when required

Benefits

As a full time benefits position, staff is eligible to enroll in medical, dental, vision, FSA, supplemental life insurance, critical illness, enhanced short-term disability, and 401(k) benefits.

Professional Level

Executive

Minimum Education Required

4-year degree


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