Under the supervision of the Director of Health and Wellness, the Managed Care Compliance Coordinator is part of the Medicaid Managed Care Liaison team. This team is responsible for ensuring that HSVS foster care children have access to all needed healthcare services through a highly coordinated approach between HSVS, the NYC Administration for Children's Services (ACS), the NYS Office of Children and Family Services (OCFS), and the Medicaid Managed Care Plans (MMCPs). Additionally, the Managed Care Compliance Coordinator will support the Care Coordination/Medicaid Managed Care department by processing foster care intakes and discharges, and by tracking services and EHR documentation to ensure compliance with City and State regulatory requirements.

The Managed Care Compliance Coordinator will support the Care Coordination/Medicaid Managed Care department with any and all of the following responsibilities, as assigned:

• Serve as a backup contact for MMCPs, and assist with performing the following:
  • Foster care youths’ MMCP enrollment, disenrollment and transitions
  • Resolve issues with children’s access to healthcare services related to, but not limited to, PCP changes, prior authorizations, referrals, and Medicaid insurance status
• Assist with informing and coordinating with the MMCP Foster Care Liaison teams to:
  • Submit transmittals for intake/discharges/PCP and primary dental provider and other changes
  • Obtain/replace MMCP member identification cards (including immediate temporary identification)
  • Facilitate a single case agreement when a child is placed outside of the MMCP’s service area or provider network
  • Address procedural or communication issues impacting continuity of care
• Maintain children’s eligibility for health insurance through regular verification of insurance status
• Document promptly all MMCP insurance processing updates in department’s shared FC List spreadsheet
• Interact with HSVS’s 29-I Clinic team and Medicaid billing staff, and maintain current insurance information in NextGen EHR
• Coordinate with HSVS Case Planning and Children’s Health Home (CHH) staff, community healthcare providers, and pharmacies to ensure MMCP enrollees’ access to services
• Coordinate benefits and assist with provider selection and scheduling of medical/dental appointments, as needed
• Be available during business hours to address any healthcare access issues requiring immediate attention
• Assist with consent and/or confidentiality issues, court ordered services and fair hearings
• Attend trainings and workgroup meetings to maintain up-to-date knowledge of 29-I and Medicaid managed care policies
• Process new foster boarding home (FBH) intakes upon placement with HSVS, including:
  • Required timely completion of Medical Necessity form in NextGen EHR
  • Scheduling and follow-up for all required 30-day initial medical, dental, behavioral health assessments
  • Obtain family medical history, and signed HIPAA and routine/emergency consents
  • Hand off cases to assigned FBH Care Coordinators upon required timely completion of above tasks and Comprehensive Treatment Plan in NextGen EHR
  • Participate in FTC/transitional team meetings, as needed
  • Process FBH discharges, including:
    • Ensure timely final discharge medical exam
    • Provide required Medical Discharge Checklist documentation (immunization records, last medical appt., etc.) from NextGen EHR
    • Assist with Medicaid discharge planning process
• Document all actions and communications in NextGen EHR, and assist with obtaining youths’ health records from community providers
• Track through Excel and/or NextGen, and report out as requested, services provided for HSVS youths in care including, but not limited to, the following:
  • Annual/required healthcare exams (medical, behavioral, dental)
  • Specialist referrals
  • Initial healthcare assessments for new intakes
  • Communication of youths’ rights to sexual and reproductive health
  • Health insurance coverage, including for out-of-state (ICPC) youths, and status of any follow-up to resolve insurance issues
• Perform data entry related to the above, including backfilling of data in NextGen EHR
• Engage in ongoing review of departmental policies, procedures and practices to make recommendations for quality improvement
• Perform other tasks as assigned within the reasonable scope of duties of the position

The Managed Care Compliance Coordinator must have:

• Bachelor’s degree in health or social services, or equivalent
• One or more years working in a healthcare environment and/or in the child welfare system
• Experience with, expertise, and/or knowledge of the child welfare system and the unique complex needs of the foster care population, foster care healthcare services requirements and foster care Medicaid Managed Care policies/ operations
• Good understanding of medical procedures and medical terminology. Medical assistant or similar clinical background preferred
• Experience with Electronic Health Records (EHR). NextGen EHR experience a plus
• Team player with excellent communication and interpersonal skills
• Strong attention to detail with excellent organizational skills
• Proficiency in Microsoft Office, including Outlook and Excel

Benefits:

• Rewarding Work in a team environment;
• Paid vacation, sick, personal days and holidays;
• 403(B) retirement plan with employer contribution;
• Health, dental, vision and life insurance;
• Employee Assistance Program (EAP);
• Flexible spending account (Dependent Care, Medical, Parking, and Transit);
• Employee Appreciation Programs and Events;
• Tuition Assistance Program;
• Professional Development opportunities;
• Gympass Discount
• Verizon Wireless Discount;
• BJs Membership discount;
• Discounts on Broadway tickets, movie tickets, theme parks, sporting events, gift certificates & more.