Managed Care Associate (Finance)

A Managed Care Associate manages all health plan contracts, health plan relations, credentialing, provider enrollment, provider maintenance and general operations for USF Health Physicians. This includes all of the health plan payor agreements after the contract is executed and any files or storing of the contract. This is in support of multiple departments to include Revenue Cycle Operations, Faculty Affairs, Medical Affairs, Quality, Compliance as well as work with external partners to ensure each physician is represented accordingly. This role works closely with other Managed Care Associates and will coordinate any activities needed to address physician credentialing, provider enrollment, and managed care requirements. This role is key in communicating to leadership any outstanding issues and resolution management.

Nature of Work: The Managed Care Associate position reports to the Sr. Director and Manager of Credentialing and Provider Enrollment with USF Health. This role collaborates with the Sr. Managed Care Associate, and Credentialing & Compliance Administrator.This position requires a high school diploma or equivalent, with 3 years of credentialing/managed care or business-related experience.

FLSB1310 Equivalency:
4 years of directly relevant experience may be substituted for bachelor's degree.
6 years of directly relevant experience may be substituted for master's degree.

This position may be subject to a Level 1 or Level 2 criminal background check.

Applicants for USF employment are entitled to request reasonable accommodation(s) in the application process. A request is to be made at least five (5) working days prior to the time the accommodation(s) is needed. Contact the USF ADA Lead ( hr-ADA-Request@usf.edu ) to coordinate your accommodation request.The University of South Florida is a high-impact global research university dedicated to student success. Over the past 10 years, no other public university in the country has risen faster in U.S. News and World Report's national university rankings than USF. Serving more than 50,000 students on campuses in Tampa, St. Petersburg and Sarasota-Manatee, USF is designated as a Preeminent State Research University by the Florida Board of Governors, placing it in the most elite category among the state's 12 public universities. USF is a member of the American Athletic Conference.
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Working at USF
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With more than 16,000 employees at USF, the University of South Florida is one of the largest employers in the Tampa Bay region. At USF you will find opportunities to excel in a rich academic environment that fosters the development and advancement of our employees. We believe in creating a talented, engaged and driven workforce through on-going development and career opportunities. We also offer a first class benefit package that includes medical, dental and life insurance plans, retirement plan options, tuition program and generous leave programs and more.
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To learn more about working at USF please visit: Work Here. Learn Here. Grow Here .

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• Develop and maintain contracting records. Coordinating activity and review of physician files to ensure completion of contracting process.
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• Perform activities involved in the end to end contracting of USF Physicians and determine the best process to re-contract provides in a timely manner.
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• Participate in Managed Care activities to ensure new plans and proactivity plans for credentialing goals are met.
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• Maintain storage of executed contracts/agreements and amendments.
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• Develop communication strategy for informing others of contracting/credentialing status.
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• Review and verify credentialing and recredentialing applications for completeness.
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• Ensure all required documentation is submitted.
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• Conduct primary source verification of credentials and recredentialing (e.g., education, licenses, certifications, sanctions, claims history, hospital privileges).
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• Address and resolve any issues or discrepancies in credentialing applications.
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• Provide support and guidance to applicants throughout the process.
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• Maintain and update the credentialing database (Symplr) and records.
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• Communicate with applicants regarding the status of their credentialing process.
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• Communicate with faculty affairs, internal departments, and external agencies as needed.
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• Update Monday.com with relevant information.
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• Manually generate, collate, and request completion of recredentialing applications.
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• Manage Credentials Committee meeting agendas and minutes.
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• Communicate the Credentials Committee's decisions.
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• Generate and submit regular reports on credentialing activities as needed.
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• Communicate with existing providers regarding licensure, certification expiration, and renewals.
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• Provide updates to management on credentialing status and issues.
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• Participate in training sessions to stay current with credentialing best practices.
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• Participate in managed care audits and ensure files are prepared for NCQA and/or managed care audits.
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• Audit files prior to committee review to ensure accuracy.
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• Assemble files after committee review in anticipation of selection for audits.
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• Submission of enrollment applications with government plans Medicare and Medicaid
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