12,196 Molina Healthcare jobs in the United States

Our client, a health insurance company, is looking for a Managed Care Coordinator for their Newark, NJ location. Responsibilities: Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients. Handles initial screening for pre-certification requests from phys.

Due to company growth, CommuniCare Health Services is currently recruiting a Managed Care Biller for our Corporate Managed Care Billing Department.

The position of Managed Care Biller/Collector is responsible for billing, receivables auditing, and collections activities for services provided to patients in the facilities assigned. Ultimately they are responsible for hitting their cash collection goals each month and minimizing the impact of Bad Debt for the buildings/facilities assigned to them.

All CommuniCare employees enjoy competitive wages and PTO (Paid Time Off) plans. We offer full time employees a menu of benefit options that include:

• Life Insurance and Disability Plans
• Medical, dental, and vision coverage from quality benefit carriers
• 401K with employer match
• Flexible Spending Accounts

Position Requirements:

• Knowledge of medical billing/collection practices.
• 3-5 years experience in managed care billing preferred
• Experience billing various Managed Care companies and understanding the requirements for each payor
• Claim appeal/resolution expertise preferred
• Must have a high degree of attention to detail.
• Strong verbal and written skills required in order to interact with insurance companies to resolve unpaid claims via telephone and written correspondence.
• Basic computer literacy and skills.
• Strong organizational skills a must.

About Us: A family-owned company, we have grown to become one of the nation's largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, "to reach out with our hearts and touch the hearts of others." Through this effort we create "Caring Communities" where staff, residents, clients, and family members care for and about one another.

Job DescriptionBring your whole self to exceptional care. Cedars-Sinai was tied for #1 in California in U.S. News & World Report's "Best Hospitals " rankings, and it's all thanks to our team of 14,000+ remarkable employees!What will I be doing in this role?In collaboration with the department Senior Vice President and department directors, the Managed Care Coordinator supports the strategic, operational, and administrative functions of the Managed Care and Payer Relations department. Supports critical initiatives, contract implementation, credentialing, payer relations, and departmental compliance. Works closely with leadership to ensure department goals align with broader Health System objectives.The Managed Care Coordinator collaborates with leadership, clinical departments, and external partners to ensure accurate documentation, timely communication, and effective execution of managed care functions. In this multifaceted role, the Managed Care Coordinator assists with payer Requests for Information (RFIs), contract documentation, and Letters of Agreement (LOAs), while also managing credentialing tasks, onboarding, and regulatory reporting. The position also supports departmental budgeting processes, provides operational support, and contributes to special projects related to payer strategy, compliance, and service delivery across the health system. Duties include: Coordinates and supports managed care operations and departmental services, including drafting and tracking patient-specific Letters of Agreement (LOAs) and providing backup for health plan inquiries. Facilitate drafting and production of payer contract amendments and other related documents as part of onboarding process of new affiliated physicians and physician groups. Develops, implements and manages departmental policies and procedures related to payer and specialty contract and compliance monitoring to ensure alignment with internal and external reporting requirements. Completes credentialing and recredentialing applications for health plans covering faculty practice and affiliated entities (e.g., CSMC, MDRH). Collaborates with leadership to drive cross-functional process improvements, enhance communication, and promote collaborative problem-solving. Leads or assists in coordinating the annual AHA hospital services survey responses for areas related to managed care. Manages Requests for Information (RFIs) from health plans and payers for specialty services, reviewing submissions for appropriateness and advancing concerns (e.g., financial or contract-related data) to leadership. Coordinates and communicates RFI deadlines and follow-ups with internal departments and payers to ensure timely responses. Collaborates with transplant program leaders to compile clinical and administrative data for solid organ and bone marrow transplant RFIs and Center of Excellence proposals. Maintain current and accurate compliance documentation (e.g., licensure, insurance, JCAHO) on shared drives to support audits and regulatory readiness. Works with department leadership to develop and manage the annual budget, including data entry into Axiom and liaising with Finance for revisions and analysis. Monitors expenditures and controlling departmental budget, performs account analysis and preparation of monthly variance reports for leadership review. Oversees administrative HR functions including timecard approvals, time-off tracking, new hire orientation, and mandatory training (e.g., C-S Fire and Disaster Plans). Coordinates technical and operational supports needs (e.g., EIS support tickets and requests for tools like DocuSign) to maintain workflow continuity. Leads the creation, development, and ongoing maintenance of a comprehensive payer database to support effective communication and ensure contract compliance. Distributes contract amendments, payer notifications, and provider manual updates to relevant internal collaborators. Develops and maintains databases and tracking tools to monitor RFI status and prepare and submit monthly outcome reports.QualificationsRequirements:Bachelor's degree in business administration, finance or another relevant major required.A minimum of 5 years' experience in managed care, healthcare administration, credentialing, or payer relations, preferably in an academic medical center or integrated health system required.In this role you will demonstrate initiative, resourcefulness and problem- solving skills in organizing and prioritizing work and establishing systems and procedures. The position requires strong customer service and interpersonal skills to effectively work with payers, administration, attorneys and co-workers.Why work here?Beyond outstanding employee benefits including health and dental insurance, paid vacation, and a 403(b) we take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation.

Req #: 3397 Job ID: 14854 Job Location: New York, NY Zip Code: 10041 Category: Office and Administrative Support Agency: Medical Associates, P.C. Status: Regular Full-Time Office: Hybrid Salary: $38,545.53 - $48,181.92 per year Rooted in Jewish values and traditions, and consistent with the highest standards of quality care, MJHS Health System is a premier provider of health services in the greater metropolitan area and beyond, ensuring access to health, supportive and community-based services across the continuum of need. Our MJHS Medical Associates, P.C. is a group of Nurse Practitioners, Physician Assistants, RN Case Managers and LPN's who provide care to Elderplan members who are residents of assisted living and long term care facilities, as well as to those living at home.The MJHS Difference At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.Benefits include: Tuition Reimbursement for all full and part-time staffGenerous paid time off, including your birthday! Affordable and comprehensive medical, dental and vision coverage for employee and family members Two retirement plans ! 403(b) AND Employer Paid PensionFlexible spendingAnd MORE! MJHS companies are qualified employers under the Federal Government's Paid Student Loan Forgiveness Program (PSLF) Responsibilities: Ensure high quality, cost-effective care and services for Elderplan members through support of professionalCare Management and/or Clinical Service activities. This position supports all aspects of care coordination forour ISNP, IESNP and Elderplan Plus members in compliance with all departmental and regulatory requirements.The position requires excellent communication and organizational skills. Qualifications: High School Diploma or equivalent; College Degree preferredOne-year prior managed care experience preferredPrior experience in a health care setting preferredFamiliarity with utilization management/case management

Location:Hawaii Cancer CarePay Range:$20.90 - $34.82Job Description Summary: A Managed Care Coordinator serves as the liaison between the Financial Counselor and the Utilization Management and Intake team by coordinating managed care review of benefits, authorizations, referrals and streamlining communication of the managed care components for patient services. Performs the quality control function for pre-certification and prior authorization. The Managed Care Coordinator ensures the patients' insurance benefits are kept up to date in the electronic medical records (EMR) and billing software while also verifying the patient's services meet coverage appropriateness.Primary Job Duties & Responsibilities:Monitors and coordinates internally and externally with the insurance company on the pre-certification and prior authorization processes, including peer-2-peer and appeals, seeking support from provider or pharmacy team when applicable.Review assigned patient(s) and/or Physician schedules for upcoming visits and/or treatment to evaluate coverage criteria with payor guidelines and preferred treatment.Review patients' treatment plan(s) and identify if insurance benefit coverage is active, all unplanned exceptions are to be communicated to provider/clinic team immediately.Review and identify new treatment orders.Communicate openly and routinely throughout the course of the workday with various teams such as the Financial Counselor Team, Intake Team, UM team and coworkers through Teams, phone calls, emails and in person to discuss items as needed to complete managed cares.Work closely with outside entities to ensure full collaboration and completion of forms and items needed in a timely and sometimes urgent manner.Understand and comply with all Federal and State laws and regulations pertaining to patient care, rights, safety, billing, and collections.Will be expected to work overtime when given sufficient notice of required overtime.Keep work area and records in a neat and orderly manner.Maintain all company equipment in a safe and working order.Adhere to all AON and departmental policies and procedures, including Revenue cycle policies and procedures.Performs other duties and projects as assigned.Job Qualifications and Requirements:Education: High school Diploma or GED required. Further education or degree a plus Certifications/Licenses: Previous Experience (including minimum years of experience):A minimum of two-years prior experience in the healthcare field, preferably in a clinical or business office setting required.Prior Medical terminology.Prior Medical insurance verification.Prior Verifying pre-certification and/or prior authorization with medical insurance.Excellent proven verbal and communication skills needed.Proven Insurance knowledge requirements including an understanding of medical terminology, ICD9, ICD10 and CPT codes.Ability to calculate and collect patients' responsibility and insurance co-pay/coinsurance.Core Capabilities:Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills. Must be detailed oriented with the ability to exercise independent judgment.Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.Communication Skills: Good command of the English language. Second language is an asset but not required. Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback.Customer Service & Organizational Awareness: Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations.Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability work independently with limited supervision. Ability to work remotely effectively as required.Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.Computer Skills: Proficiency in MS Office Word, Excel, Power Point, and Outlook required.Ability to use multiple screens to perform required job functions.Ability to navigate multiple applications and tab in and out of workflow to complete tasks.Travel : 0%Standard Core Workdays/Hours: Monday to Friday 8:00 AM - 5:00 PM. #AONA

Bring your whole self to exceptional care. Cedars-Sinai was tied for #1 in California in U.S. News & World Report's "Best Hospitals " rankings, and it's all thanks to our team of 14,000 remarkable employees! What will I be doing in this role? Care Coordinator, Coordinator, Department Leader, Leadership, Support, Health, Healthcare

The Managed Care Coordinator will coordinate the provision of inpatient chemical dependency treatment services with third party payers, including commercial insurers and managed care companies. He/She will coordinate inpatient care with other assigned staff through entire treatment cycle. Facilitate authorization and concurrent review processes for all third party insured inpatients. Perform comprehensive psychosocial assessments on prospective patients, as needed. Work collaboratively and manage all relevant information from medical, nursing, and counseling staff needed to present patient case to insurance entities to attain proper authorization for patient stays. Maintain and disseminate updated insurance entity information including changes in managing entities, plan changes, hours of operation, contact information and all other relevant information with regards to authorization policies and procedures. Work in conjunction with BHS Central Intake staff on coordination of patient's insurance benefits. Performs care management functions for inpatients, as needed. Maintain relationships with other agencies and individuals wishing to make referrals to the program; coordinate discharges as needed. Remain current on policies and procedures of insurance companies to facilitate coordination of program's financial responsibilities. Maintain and prepare statistical data, reports, and correspondence as required for agency, county and state, as assigned. Maintain clinical records in compliance with all regulatory bodies and SJRH/BHS policies and procedures.

CASAC, LMSW, LMHC or other NYS recognized QHP required. Five or more years of treatment experience specific to chemical dependency treatment is required; inpatient detoxification and rehabilitation experience preferred. 3-5 years of experience dealing with managed care/ insurance companies is required.

Job Type Full-timeDescriptionSummary Responsible for all aspects of payer relations. Overall goal of, managing payor relationships and contract negotiations to meet the organization's strategies and financial success. Cultivates relationships to assist with problem resolution while positively advocating and removing barriers to access to ensure coverage and reimbursement. Essential Duties Contract negotiations: Lead contract negotiations with payers to secure favorable reimbursement rates and terms for all segments of IBJI. This includes physicians services in office and surgical setting, imaging, rehabilitation and ASC's. Analyze the potential impact of contract renegotiations by modeling the financial impact.Market access strategy development: Contributing to the development and execution of strategies to gain access to payer networks and maximize patient access to services.Payer policy analysis: Monitor and analyze payer policies, coverage guidelines and reimbursement methodologies to identify potential challenges and opportunities. Educate leadership, revenue cycle and operations of these challenges and opportunities.Quality management: Key knowledge of payor quality measurement tools. Collaborate with internal teams to coordinate strategy and understanding of financial and clinical implications. RequirementsJob Qualifications Bachelor's degree is required, advanced degree is preferred.Experience in contract negotiationsDeep knowledge of healthcare, managed care strategy, pricing and medical reimbursement environment required.Proven ability of successfully managing complexity, solving problems and building strong relationships.Ability to work well independently as well as collaboratively; self motivated and disciplined to meet deadlines in the context of competing priorities and projects; lead and work effectively with cross-functional teamsComputer literacy, including high level of competency in ExcelBase salary offers for this position may vary based on factors such as location, skills and relevant experience. We offer the following benefits to those who are benefit eligible (30+ hours a week): medical, dental, vision, life and AD&D insurance, long and short term disability, 401k program with company match and profit sharing, wellness program, health savings accounts, flexible savings accounts, ID protection plan and accident, critical illness and hospital benefits. In addition, we offer paid holidays and paid time off. Salary Description $71K-$95K annually based on experience level

General Job Purpose

The Managed Care Specialist is responsible for the identification, tracking, and trending of payment variances. Additionally, the Specialist will provide root cause analysis by payor, working with the payors and key stakeholders to resolve those variances improving financial performance. The Specialist will work with key stakeholders to improve collections and change payer behavior while improving overall communication to successfully execute departmental and company goals.

What You Will Be Working On

Performance
• Responsible for the contract build in the EMR and serves as the subject matter liaison for any external contract variance tools or systems
• Identify, track, trend, and provide root cause of payor variances
• Prepare necessary documentation that allows for the collections of those variances
• Educate key stakeholders on actions needed to eliminate variances, when variances are due to internal processes i.e. coding, billing etc.
• Assist Provider Enrollment with analytics needed, trending payor response times, application denials/delays by payors
• Work with leaders to identify areas of revenue loss by service/CPT, identifying lesser-of
• Review and monitor contractual allowance calculations and variances in expected reimbursement. Identify origin of variance (under/over payment) or modeling discrepancies and perform routine root cause analysis to identify system and/or contract modeling errors
• Provide ongoing support and tools for internal and external customers related to MVP's Managed Care
• Collaborate with key stakeholders to ensure appropriate facility/ASC credentialing needs are addressed
• Analyze data, providing trending and identify root cause within Managed Care and Credentialing
• Resolution and collection of variances by making calls to the payer, appeals, portal appeals, written appeals, payor calls etc.
• Collection and maintenance of payer correspondence and bulletins. Effectively communicating updates/changes to internal customers
• Develop SOPs for consistency and alignment with company goals
• Perform other duties as assigned

Communication
• Communicate effectively with all stakeholder groups to review performance, discuss issues impacting financial performance, share information and key updates, and provide education:

- Payor

- Internal team members/leadership

- Third parties and vendors

WHAT WILL MAKE YOU AWESOME
• Exemplary working knowledge and interpretation of provider and payor contracts and fee schedules to determine valid variances
• Excellent written and verbal communication skills
• Highly organized, dependable, and focused on quality and service
• Self-directed, metrics minded, and unafraid of challenging the status quo
• Demonstrated teamwork skills and the ability to work with different teams, entities
• Proficiency using Microsoft Office, such as Outlook, Word, Excel, and PowerPoint
• High ethical standards
• Ability to work with a high attention to detail

WHAT YOU KNOW:

To be successful in this role you will have the following experience or knowledge:
• Bachelor's degree in finance or business-related a plus; or commensurate experience
• 5+ years in payer relations/contracts/fee schedules aiding in payment variance identification and resolution or related industry experience