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Medicaid Managed Care (MMC) Liaison

Hudson Valley NY

Posted: 11/08/2018 Department: Healthcare Finance and Operations Job Number: 5126

Title: Medicaid Managed Care (MMC) Liaison

Location: Hudson Valley Area, NY

Industry: Healthcare

Occupational Category: Managed Care/Finance

Hours: Full-time

Description: Hiring a Medicaid Managed Care (MMC) Liaison is for a multi-faceted nonprofit organization that helps young people maximize their full potential. The Medicaid Managed Care (MMC) Liaison will be responsible for developing and maintaining positive working relationships with Medicaid Managed Care Plans (MMCPs). The Medicaid Managed Care (MMC) Liaison will coordinate with the MMCPs to ensure that there is a highly-coordinated approach between the organization and MMCPs and ensure that the children have access to all medically necessary care provided by the organization.

Responsibilities:

  • Coordinate with the MMCP’s foster care liaison
  • Assist with MMCP enrollment, disenrollment and transitions
  • Develop and implement a system of communication that includes: Mechanisms for sending and receiving information, including new enrollments or dis-enrollments from MMCPs; Foster Care Intake and Discharge status; Changes in placement or address; Changes in health status; Issues related to billing, utilization management and credentialing
  • Assist with foster care placement changes including: Access to health care; Facilitating a single case agreement when a child is placed outside of the provider network
  • Interact with clinical and billing staff
  • Refer children for needed services and assist in provider selection
  • Coordinate with health care providers, including school and community-based services
  • Maintain eligibility for public or private health insurance
  • Support all business functions related to Article 29-I licensure
  • Assist with court ordered services and fair hearings
  • Attend required training and read all required literature related to NYS MMC Systems transformation and foster care

Education Requirements:

  • Bachelor’s degree required, Master’s degree preferred
  • 5 years’ work experience demonstrating steadily increasing levels of responsibility and accountability

Experience Requirements:

  • Experience in managed Medicaid contracting and networking required
  • Knowledge of provider contracts/reimbursement interpretation preferred
  • Experience, expertise, and knowledge of the child welfare system, foster care healthcare requirements, the unique complex needs of the foster care population, and Medicaid Managed Care policies and operations
  • Experience with claims processing, provider billing and provider relations preferred

Desired Skills:

  • Excellent communication (oral and written) and interpersonal skills
  • Ability to maintain and uphold professional boundaries
  • Ability to handle confidential material in a responsible manner
  • Ability to travel to all agency locations when required
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