Managed Care Liaison
Managed Care Liaison
Northern Rivers is seeking a Managed Care Liaison specializing in Medicaid enrollment and billing. In this role, you would review and verify Medicaid managed care enrollment and eligibility for our clients, review for accuracy and timeliness the documentation for the billing of Medicaid per diem, as well as evaluate authorizations and documentation for referrals, procedures, CFTSS services and HCBS respite.
Essential Duties and Responsibilities of a Managed Care Liaison:
- Coordinate with the LDSS liaison and the managed care company liaison to ensure that children in foster care receive appropriate health and behavioral health care.
- Provide communication between program, county, finance and managed care companies in the following areas:
- Medicaid coverage during placement and at discharge
- Primary Care Provider changes
- Managed care enrollment and disenrollment
- Obtaining notices from the Managed Care Plans
- Access to health services
- Changes in foster care placements
- Billing issues
- Consent and Confidentiality issues
- Court orders
- Knowledge of New York State health coverage options.
- Ensure that children have access to needed services and know the managed care plans prior authorization requirements.
- Ensure that services on treatment plan are being carried out and documented correctly.
- Be a point of contact and resource to the program, finance and managed care company around billing, (i.e., is child eligible, did billing occur, were we paid, if not why?)
- Ensure that releases are properly filled out and that consents and confidentiality are kept for all medical and behavioral health needs.
- Work requires 25-50% community travel/visits to client homes.
- Effective communication and organizational skills are very important as this position ensures that services on treatment plans are being carried out and documented correctly in order for clients to receive appropriate health care needs.
Your Education and Experience:
- Managed Care Liaison delineation:
- Liaison 1: Associates degree plus a minimum of three years' experience
- Liaison 2: Bachelor's Degree plus a minimum of two years' experience
- Experience in a specialized area or technical field (such as Residential Care, Child Care, Food Service, Nursing, Accounting) in regards to Medicaid billing a plus.
- Computer/database literate in a Windows environment.