Join Our Team!
KidsPeace National Centers of New England has an opening for a Managed Care and Program Compliance Coordinator to work at its Graham Lake Campus located in Ellsworth, ME. The Managed Care and Program Compliance Coordinator resolves managed care operational issues such as authorization for services, billing, and claims payment. Ensures all clinical operations comply with Medicaid guidelines and other managed care policies. Maintains managed care contracts and educational information databases.
- Experience with case management, larger systems and/or direct casework preferred.
- Four years in Human Services or related field.
- Strong computer skills.
- Excellent verbal and written skills.
- Maintain all billing systems and databases that include, but are not limited to APS, SMS, and Vital Signs. Ensure authorizations for APS, SMS, MIHMS and Vital Signs are entered.
- Complete MaineCare verification eligibility for clients.
- Perform regular billing data entry tasks to meet deadlines (SMS, Vital Signs).
- Complete billing audits, communicate results as necessary, and complete follow-up tasks as needed.
- Analyze client Individual Education Plans, Treatment Plans, service provider notes, service logs and any other applicable billing documentation to ensure services provided are billable. Take action, through positive collaboration, with service area supervisors and service providers, as necessary to correct errors.
- Facilitate billing-related meetings and staff member trainings as needed.
- Maintain working knowledge of MaineCare billing rules and regulations; disseminate information to appropriate personnel both locally and with headquarters Accounts payable and Compliance; and create/revise billing systems and documentation as necessary.
- Maintain working relationship with Patient Accounting to communicate rate and procedure code changes; communicate provider NPI numbers, location numbers, rendering provider NPI numbers; collaborate on claim(s) issues; and provide regular billing updates.
- Operationalize the model of care as evidenced by role modeling, liaison with larger systems, facilitating quality improvement and customer relationships.
- Reporting on an as needed basis to Compliance, to include assisting in establishing methods to improve efficiency and quality of services and reducing vulnerability to fraud.
Full-Time Benefits Include:
- Health, Dental and Vision Insurance
- Life and Disability Insurance
- Paid Holidays, Vacation Time and Floating Holiday
- Company Paid Training
Applicants selected for an interview are encouraged to provide three (3) Letters of Recommendation as well as education documentation (transcripts/diploma) for the first interview.
KidsPeace is proud to be an equal opportunity employer supporting workforce diversity.