Medicare Part D Operations & Credentialing Coordinator

Mount Sinai Medical Center; Town of Florida (NY); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Health benefits

Life insurance

Retirement plan

Paid time off

Tuition reimbursement

Employee assistance program

Job summary

Mount Sinai Medical Center seeks a skilled healthcare administrator to lead Eldercare-related claims processing and network credentialing within its managed care operations. The role focuses on ensuring timely payments, accurate reporting, and regulatory compliance across Medicare, Medicaid, and Part D programs.

You will coordinate with providers, vendors, and MSMC departments to maintain compliant networks and improve operational efficiency. A BS degree and health plan experience are preferred.

Qualifications

• Experience in health care business office or health plan operations preferred.
• Knowledge of claims processing, auditing, and enrollment workflows.
• Familiarity with Part D, CMS reporting, and payer communications is helpful.

Responsibilities

• Acts as the point person for TPA activity, including Eldercare claims processing and reporting.
• Reviews and tracks claim status, denials, and payments with providers/vendors to resolve issues.
• Maintains PreCheck/Pend reports with timely follow-up and accuracy.
• Monitors health plan payments including Medicare/Medicaid and coordinates payer follow-ups.
• Oversees provider network credentialing, contracting, and orientation; ensures regulatory compliance.
• Collaborates between MSMC Managed Care and Eldercare to resolve credentialing issues.
• Manages Part D activities, CMS reporting, and compliance items.
• Maintains network provider/vendor lists and CMS universes; handles single case agreements as needed.

Skills

Healthcare administration

Claims processing

Credentialing

Contracting

Regulatory compliance

Education

Bachelor's degree (preferred)

Tools

Accounting software

Job description

Mount Sinai Medical Center seeks a skilled healthcare administrator to lead Eldercare-related claims processing and network credentialing within its managed care operations. The role focuses on ensuring timely payments, accurate reporting, and regulatory compliance across Medicare, Medicaid, and Part D programs.

You will coordinate with providers, vendors, and MSMC departments to maintain compliant networks and improve operational efficiency. A BS degree and health plan experience are preferred.