CLASSIFICATION TITLE:
Network Operations Coordinator
SALARY:
$68,348.95 - $88,403.65
DEPARTMENT:
Community Mental Health
Closing Date:
02/08/2024 12:00 a.m.
FLSA STATUS: Non-exempt - Overtime pursuant to Human Resources and Labor Relations Policy
EMPLOYMENT RELATIONSHIP: Just cause subject to probationary period
GENERAL SUMMARY:
Under direction, assists in the operational oversight and management of Macomb County Community Mental Health (MCCMH) Provider Network Management department to include provider procurement, provider education, provider evaluation, contract negotiations, monitoring of ongoing service provision, compliance with contract provisions and contract management for assigned paneled providers.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
Assists in the implementation of the overall Quality Plan for MCCMH.
Assists in service provider proposal review and negotiations with new contract service agencies.
Assists in the coordination of written contract service agreements and monitoring the provider’s adherence to contractual obligations.
Maintains an ongoing and professional relationship with contract service providers, which includes quarterly contract reviews with the assigned contract agencies.
Provides technical assistance to assigned contract providers (authorization process, development of clean claims, provision of services, coordination within MCCMH to obtain answers to inquiries).
Assists in monitoring compliance of the contract agency with current Federal, State and County policies and/or regulations (CARF, Corporate Compliance, MCO Policies) and works with providers to ensure compliance.
Functions as a liaison between MCCMH and the provider to facilitate the negotiation of provider contracts.
Provides recommended boiler plate language and corresponding attachments in reference to scope of services, anticipated outcomes and performance standards, claims submission instructions, negotiated reimbursement rates, as well as Recipient Rights reporting and requirements.
Ensures provider compliance with training and orientation to MCCMH, which includes contract requirements and related policies and procedures.
Provides administrative assistance and monitoring of the provider network, including participation on selected committees of MCCMH.
Assist in the collection of data for contract compliance activities, including record reviews, contact with network providers, and collaboration within MCCMH administration.
Performs related duties as assigned.
QUALIFICATIONS:
Required Education and Experience
- Bachelor’s Degree in Business Management, Public Administration or other related organizational management degrees from an accredited college or university
- Two (2) or more years of experience in behavioral health or healthcare
Preferred Education and Experience
- Master’s Degree in Health or Human Services, Hospital or Public Administration from an accredited college or university
- Two (2) or more years of experience in contract management, program management or public administration within health services including some experience with hospital inpatient services
Required Licenses or Certifications
- Possession of a valid Michigan driver’s license and operable, insured automobile for authorized travel
COMPETENCIES FOR SUCCESSFUL PERFORMANCE OF JOB DUTIES:
Knowledge of:
- Knowledge of applicable computer applications
- Michigan Mental Health Code
- MCCMH policies, rules, regulations, codes and procedures
- Medicaid Provider Manual
- Modern office procedures, methods and computer equipment
Skill in:
- Using good professional judgment and following complex directions
- Interpersonal skills necessary to develop and maintain effective and appropriate working relationships
- Performing a variety of duties, often changing from one task to another of a different nature
- Providing excellent and timely customer service
- Managing timelines and project deadlines
Ability to:
- Collaborative: Approaches all situations with a teamwork and solution focused mindset demonstrated through active participation in meetings, volunteering to assist teammates and other departments as appropriate. Examples include participation in internal and external committees, subcommittees, process improvement groups or other multi-organizational initiatives
- Accountable: Takes ownership and empowers others to do the same as evidenced by identifying solutions and acting on job responsibilities and organizational objectives, daily
- Respectful: Treats people with dignity while honoring individual differences demonstrated through use of positive and encouraging statements and/or interactions to, about and/or with colleagues and persons served; evidenced by supervisor observation, feedback from other department staff and leadership.
- Work in an environment which embraces the county’s Dignity Campaign
- Effectively speak, write, and understand the English
- Effectively speak, write, and understand a language other than English is preferred
- Understand and carry out oral and/or written instructions
- Accurately organize and maintain paper documents and electronic files
- Maintain the confidentiality of information
- Work independently
