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Remain knowledgeable of services available and utilized by Medicaid consumers eligible for MLTC, i.e., In Home Services for the Elderly Program, Housing Options, Government Benefits, shopping assistance, exercise classes, meals on wheels, etc.
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Refers patients to various health care setting departments and outside agencies, such as Medicaid, New York State Unemployment Insurance, Social Security and Public Assistance for possible benefits.
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The Credentialing Coordinator is responsible for maintaining the confidentiality of all Medical Staff related information, organizing and preparing for committee meetings, and ensuring compliance with the Medical Staff Bylaws, accrediting and regulatory agencies (i.e., Joint Commission, Centers for Medicare & Medicaid Services, NCQA) in regard to credentialing while developing and maintaining a working knowledge of the statutes and laws.
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The Enrollment Coordinator must ensure that all assignments are completed accurately and in a timely manner in accordance with NYSDOH Medicaid guidelines, MLTC provider regulations, and agency policies and procedures.
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Assure that each person residing in shelter is receiving or has applied for the appropriate level of VA, HRA, SSI, SSD, Medicaid, Medicare, and other entitlements. Develop and maintain relationships with housing providers, HRA, SSI, and/or the Veterans Administration.
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About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
$100,000 - $110,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Plans, coordinates, delivers and manages comprehensive healthcare services for individuals requiring primary care case management, including but not limited to those enrolled in the NYS Medicaid Managed Care Program.
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Additional recent significant cases include the indictment and arraignment of the owner of an NYC pharmacy for allegedly stealing millions from Medicaid; the sentencing of a Bronx clinic owner for defrauding New York State out of more than $4 Million in false Medicaid claims; and the extradition, arrest, and arraignment of a Medicaid fraud ringleader.
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Effectively communicate and appropriately collaborate with the Market Access team to ensure strategic alignment and effective implementation of the clinical strategy for National and Regional Managed Care accounts, covering all books of business (e.g., Commercial, Managed Medicaid, Fee-for-Service, Medicare, PBMs, and Exchange Plans.
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Knowledge of City, State, and federal resources for individuals with developmental disabilities, including but not limited to EI, CPSE, CSE, OPWDD, Medicaid waiver, ACCES-VR, Social Security, etc.
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A general list of functions required for this role are listed below: Medicare/Medicaid billing Private/NAMI billing and collections Billing Managed Care & MLTC Calling Insurance companies regarding payments.
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Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. The Enrollment Coordinator is expected to: utilize various automated systems, such as: MCO, MP, ePACES, and the Response File Reader.
$38,545.53 - $48,181.92 a yearPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Activities for benefit programs such as Medicaid, NYC Care, SNAP, WIC, FairFares, etc. Minimum Qualifications:Fluent in English, Spanish required, French/Wolof, Haitian Creole, Russian, Ukrainian.
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Requires on-going knowledge of local and national resources, including but not limited to Social Security, Medicare, Medicaid, other HRA benefits, additional state/county programs and resources, and the ability to link callers to appropriate organizations for needs.
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Develop and maintain liaison activities with H.R.A. Public Assistance and Medicaid Administrators and Workers, to assist eligible residents in securing Public Assistance and Medicaid by acting as a personal advocate through telephone or personal visit/contact.
$23.07 - $25.82 an hourFull-timeExpandApply NowActive JobUpdated Today
medicaid job Company: New York State Civil Service in Bronx, NY
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