Medicare Part D Operations Coordinator

Mount Sinai Medical Center of Florida, Inc.; Town of Florida (NY); On-site; USD 66,000 - 90,000; Full time

Benefits offered by this job

Health benefits

Life insurance

Long-term disability coverage

Healthcare spending accounts

Retirement plan

Paid time off

Pet Insurance

Tuition reimbursement

Employee assistance program

Wellness program

On-site housing for select positions

Job summary

Mount Sinai Medical Center of Florida, Inc. is seeking a diligent administrator to manage Eldercare claims processing, enrollment, credentialing, and regulatory reporting. You will coordinate with providers, vendors, and MSMC departments to ensure timely payments, accurate claims, and compliance with CMS rules.

The role supports the Eldercare Managed Care Provider Network, conducts provider orientation and audits, and maintains essential documentation to meet policy and regulatory requirements.

Qualifications

• Bachelor's Degree preferred.
• Certifications in medical coding or medical records helpful.
• At least 2 years prior experience in a health care business office, preferably Medicare/Medicaid health plan.
• Experience in health plan claims, auditing, credentialing, contracting, Part D, compliance, AP, and related functions.

Responsibilities

• Serve as the point person for all Eldercare activities including claims processing, appeals, denials, payments and reporting.
• Review and track current, denied and suspended claims to ensure accuracy and prompt resolution.
• Manage weekly PreCheck and Pend Report and ensure timely follow-up.
• Oversee health plan payments including Medicare and Medicaid and address short or missed payments.
• Assist with plan enrollment activities and ensure timely eligibility and enrollment, with disenrollments tracked.
• Support day-to-day Eldercare Managed Care Provider Network activities, including contracting, screening and credentialing.
• Track network contracts and credentialing items to stay compliant with regulations.
• Perform provider orientation and audits; liaise between MSMC Managed Care and Eldercare to resolve credentialing issues.
• Coordinate orientation and updates for network providers; maintain provider/vendor directories.
• Assist with Part D activities, CMS reporting, and compliance requirements; coordinate with HR and other MSMC departments.
• Manage Eldercare Accounts Payable and ensure timely processing of invoices; assist in compliance reporting.
• Support regulatory needs, license renewals and respond to external requests.

Skills

Healthcare billing

Auditing

Credentialing

Regulatory compliance

Accounts payable

Education

Bachelor's Degree

Tools

Medicare/Medicaid knowledge

CMS reporting

Part D

Vendor management

Job description

Mount Sinai Medical Center of Florida, Inc. is seeking a diligent administrator to manage Eldercare claims processing, enrollment, credentialing, and regulatory reporting. You will coordinate with providers, vendors, and MSMC departments to ensure timely payments, accurate claims, and compliance with CMS rules.

The role supports the Eldercare Managed Care Provider Network, conducts provider orientation and audits, and maintains essential documentation to meet policy and regulatory requirements.