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.