Managed Care Coordinator
Tennessee Oncology · Clifton Park
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.