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Senior Coordinator, Provider Relations - PACE
Category: Other
  • Your pay will be discussed at your interview

Job code: lhw-e0-89804662

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Loretto Management Corporation

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  Job posted:   Fri May 18, 2018
  Distance to work:   ? miles
  1 Views, 0 Applications  
Senior Coordinator, Provider Relations - PACE
The Senior Coordinator, Provider Relations manages provider relations for the PACE program. Ensures timely maintenance and reporting regarding contracted provider information. Develops and maintain policies and procedures for provider relations. Represents the program with outside agencies, government agencies, etc., as needed. Manages contracts and relationships for the PACE contracted network. Addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations. Primary contact/account manager for all aspects of enrollment and disenrollment from PACE CNY and New York State. Per

Job Description.

+ Reviews the provider relations programs for adherence to all corporate policy and procedures and relevant third party regulations and to enhance the quality of patient care.

+ Works closely with contract agencies to ensure compliance with PACE regulations and fulfillment of contractual obligations relating to provider relations activities and documentation requirements.

+ Acts as liaison between Provider Contractors and PACE CNY which includes coordinating all provider services. Educate provider offices regarding PACE capabilities and provide information on enrollment opportunities. Assists in coordination and performance of necessary site visits.

+ Coordinates quarterly submission Provider Network Data Files to NYSDOH, insuring accuracy of the data while insuring network adequacy and maintaining the provider network list.

+ Maintains a detailed inventory of all PACE contracts with appropriate parameters as well as both a complete electronic and paper contract library. Monitors the adequacy of the contracts with respect to regulatory requirements and appropriate rates. Ensures all provider contract files are up to date and appropriate documentation for each provider office is maintained. Initiates, follows through and manages new provider and vendor contracts.

+ Assists in provider credentialing activities as needed.

+ Surveys and reports on data around provider and participant satisfaction and out of plan utilization.

+ Conducts and reviews audits and makes the necessary corrections to insure the integrity of the provider and participant data in the EMR.

+ Provides in-service education to all employees and participants regarding provider relations policies and procedures. Trains and provides guidance of PACE staff to provider relations functions.

+ Conducts audits for Finance, Quality Assurance, Compliance and Provider Relations, including but not limited to proper loading and payment of contracts, participant vendor satisfaction, and provider performance.

+ Reports required information to the Quality Assurance, Compliance, Information Management, and Credentialing Provider Relation Committees.

+ Initiates process improvement groups in collaboration with interdisciplinary and administrative teams to improve areas of non-compliance or identified opportunities.

+ Attends and participates in various committees at PACE CNY as requested. Reports on projects, department and policy changes, etc. to promote communication among management team.

+ Demonstrates knowledge of PACE/D&TC Emergency Preparedness Plan and can verbalize their role during an event.

+ Work in conjunction with Marketing and Intake, Finance and the IDT to process and confirm enrollments. This includes submission to New York State (Maximus), manage communication within the organization and manage necessary data entry in the EMR.

+ Work in collaboration with the Finance Department on issues affecting participant benefits relating to Medicare and Medicaid. This includes, but not limited to Union Group Coverage, TROOP balances, Enrollment Data Validation

+ Work closely with contract agencies to ensure compliance with PACE state and federal regulations and fulfillment of contractual obligations relating to policy and procedures, relations activities, enrollments and dis-enrollments and contracting requirements.

+ Bachelor's degree in the area of Health Service Management or related field with provider relations, contracting and/or marketing experience in a managed care setting.

+ Has knowledge of commonly used concepts, practices, and procedures with the Medicare and Medicaid Programs.

+ Relies on instructions and pre-established guidelines to perform the functions of the job.

+ Effective communication skills.

+ Familiar with Microsoft Office site functionality, with advanced Excel skills.

Division Business Unit: PACE - 1

Shift: First

Weekends Required?: No

External Company Name: Loretto Management Corporation

External Company URL:

Street: 177 Lawrence Road E

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