Managed Care Coordinator

OneOncology; Town of Clifton Park (NY); Vor Ort; USD 65.000 - 85.000; Vollzeit

Zusammenfassung

OneOncology is seeking a Credentialing Specialist to support credentialing, payer enrollment, and contract activities across the Capital Region offices. This role collaborates with clinical and administrative teams to ensure timely provider participation and uninterrupted reimbursement.

You will manage CAQH maintenance, Medicaid coordination, and payer communications while ensuring accurate provider data across multiple systems and networks across Albany, Clifton Park, and nearby centers.

Aufgaben

• Maintain provider rosters and submit updates to payers monthly or on changes.
• Coordinate enrollment and credentialing for newly hired physicians and APPs.
• Prioritize Medicaid credentialing and recredentialing to minimize disruptions.
• Prepare and submit credentialing applications for various payers.
• Monitor application status and follow up with payers on pending requests.
• Maintain provider demographic information across payer databases and internal systems.
• Track recredentialing requirements and ensure timely documentation submissions.
• Assist CAQH maintenance and provider attestations.
• Assist with contract implementation and maintenance activities.
• Maintain managed care contract libraries and related docs.
• Track amendments, fee schedules, participation status, and renewal dates.
• Support payer outreach regarding contracting inquiries and network participation.
• Prepare reports on payer participation, credentialing status, and contract activity.
• Assist with reimbursement, network expansion, and payer initiatives.
• Verify payer participation and eligibility for Stem Cell and CAR‑T services.
• Track network participation requirements and transplant program approvals.
• Maintain LOAs, SCAs, and transplant network contracts.
• Monitor contract expiration dates and assist with renewals.
• Coordinate with clinical, financial clearance, and contracting teams on payer requirements.
• Assist with payer coding research and reimbursement policy reviews.
• Track coding denials and reimbursement trends.

Kenntnisse

Credentialing

Payer enrollment

Medicaid coordination

CAQH maintenance

Contracting support

Documentation tracking

Provider data management

Communication

Tools

CAQH

Jobbeschreibung

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

• 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.

Build a Career That Makes a Difference

At New York Oncology Hematology (NYOH), we’re more than just the Capital Region’s leader in cancer care and blood disorders—we’re a team of passionate professionals united by a shared mission: to provide compassionate, cutting‑edge care to thousands of patients each year. With six state‑of‑the‑art cancer centers across Albany, Amsterdam, Clifton Park, Hudson, and Troy—and a dedicated women’s imaging center, Akira Medical Imaging + Wellness—we bring advanced treatment close to home. Our team includes 35 board‑certified physicians and more than 300 cancer care specialists, all working together across medical oncology, radiation oncology, hematology and gynecologic oncology and surgery. At NYOH, we are committed to delivering excellent health care to help our patients continue to tell their story. If you’re looking for more than just a job—if you want a career with purpose—join us and be part of a community that’s changing lives and shaping the future of cancer care.