Managed Care Coordinator

Why Join Us?

• •Be part of a practice at the forefront of cutting-edge cancer care and advanced treatments
• •Access opportunities for professional growth and continuing education.
• •Work alongside a collaborative and compassionate team of experts dedicated to making a difference.
• •Enjoy the convenience of multiple locations throughout the Capital Region.
• •Contribute to groundbreaking clinical trials that shape the future of oncology care.

Discover your career potential with a practice dedicated to excellence and innovation.

Job Description:

Essential Duties and Responsibilities

Credentialing and Provider Enrollment

• •Maintain provider rosters and submit updates to payers on a monthly basis or as provider changes occur.
• •Coordinate enrollment and credentialing activities for newly hired physicians and advanced practice providers.
• •Prioritize Medicaid credentialing and recredentialing activities to ensure timely participation and minimize reimbursement disruptions.
• •Prepare and submit credentialing applications for commercial, Medicare Advantage, Medicaid Managed Care, and other third-party payers.
• •Monitor application status and follow up with payers regarding pending credentialing requests.
• •Maintain provider demographic information across payer databases and internal systems.
• •Track recredentialing requirements and ensure timely submission of all required documentation.
• •Assist with CAQH maintenance and provider attestations.

Managed Care Contracting Support

• •Assist with contract implementation and maintenance activities.
• •Maintain managed care contract libraries and related documentation.
• •Track contract amendments, fee schedules, participation status, and renewal dates.
• •Support payer outreach regarding contracting inquiries and provider network participation.
• •Prepare reports related to payer participation, credentialing status, and contract activity.
• •Assist with special projects related to reimbursement, network expansion, and payer initiatives.

Stem Cell and CAR-T Program Support

• •Assist with verification of payer participation and eligibility requirements for Stem Cell Transplant and CAR-T Therapy services.
• •Track network participation requirements and payer-specific transplant program approvals.
• •Maintain records of Letters of Agreement (LOAs), Single Case Agreements (SCAs), and transplant network contracts.
• •Monitor contract expiration dates and assist with renewals.
• •Coordinate with clinical, financial clearance, and contracting teams regarding payer requirements and network status.

Coding and Medical Record Review Support

• •Assist with payer coding research and reimbursement policy reviews.
• •Track coding-related denials and reimbursement trends.