Office Coordinator Medicare Part D

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

As Mount Sinai grows, so does our legacy in high-quality health care. Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.

Culture of Caring: The Sinai Way

Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.

Department

Job Description Summary

• Serves as the point person for all TPA activity including accountability for Eldercare including claims processing, appeals, denials, payments, all required reporting's responsibilities and keeps the Executive Director informed.
• Reviews and tracks current, denied and suspended claims (all claim status) to ensure accuracy, identify errors, process improvements and works with providers/vendors to resolve issue
• Responsible for the weekly PreCheck and Pend Report including accuracy and follow up in the required time frame.
• Tracks claims for timeliness and follows up with TPA as needed and reports claims not paid timely
• Oversees all health plan payments including Medicare and Medicaid. Identifies any short or missed payments and follows up with payer within stated timelines. Keep up with payment adjustments and write-offs. Keeps Executive Director notified of status.
• Assists with health plan enrollment activities, including ensuring all enrolled participants meet eligibility, they are enrolled timely, required documents are in place, disenrollments are processed per policy. This includes tracking of any accidental disenrollments, retro enrollments and/or enrollment revenue adjustments.
• Assists the Executive Director with for the day to day needs of the Eldercare's Managed Care Provider Network. Including identifying new providers, contracting, screening, credentialing and vetting of all providers. Responsible for tracking all network contracts and credentialing items to ensure all items are current and follows established regulations and Eldercare's policies. Performs new provider orientation and audits.
• Serves as the liaison between MSMC Managed Care and Eldercare to resolve credentialing issues.
• Coordinates orientation and annual required updates for all Network Providers
• Serves as the liaison between Eldercare and all contracted providers / vendors
• Maintains Network Provider / Vendor lists and directories including CMS required universes.
• Completes Single Case Agreements, gathers the required credentials and completes the required vetting checks when needed when a provider / vendor is needed outside of the Eldercare network
• Assists with all Part D activities including: annual bid, Fraud Waste and Abuse Plan, PBM claims, PBM reports and action items, drug rebates and discounts, Plan to Plan payments, CMS reporting and all compliance and reporting requirements.
• Works with MSMC HR, Employee Health, Education, other MSMC departments and contracted providers/vendors to ensure all PACE required employee/contractor requirements are in place and updated as regulations change and performs routine audits to ensure all required items are in place and current.
• Actively communicates with contractors to review and collect requeued HR documents to ensure Eldercare is in compliance at all times with PACE required HR documentation including the responsibility for CMS required personal universes
• Responsible for all Eldercare Accounts Payable including accurately completing the steps required in the accounting software, keeps on top of reoccurring invoices to ensure they are received and processed monthly and accurately completes the monthly ALF invoices per established process.
• Assist in Eldercare's compliance plan by collecting, analyzing and reporting identifying measures. Schedules, attends and presents compliance plan results to Eldercare staff
• Assists with Eldercare regulatory needs, license renewals and is the point person for responding to outside request for Eldercare credentials.
• Communicates with management regularly to keep them abreast of ongoing projects/issues
• Know and adhere to philosophy and goals of Eldercare.
• Participate in and support Quality Improvement initiatives

Qualifications

• License/Registration/Certification
  • N/A
• Education
  • Bachelors Degree is preferred. Certifications in medical coding or medical records helpful.
• Experience
  • At least 2 years prior experience in a health care business office, preferably a Medicare or Medicaid health plan. Prior experience in health plan claims and auditing experience helpful. Experience in health plan credentialing, contracting, Part D, health care compliance, accounts payable, and/or related business office functions preferred.

Benefits

• Health benefits
• Life insurance
• Long-term disability coverage
• Healthcare spending accounts
• Retirement plan
• Paid time offPet Insurance
• Tuition reimbursement
• Employee assistance program
• Wellness program
• On-site housing for select positions and more!

Certification

Degree Requirements: