Job Title: Managed Care Operations Coordinator
Location: Columbus, Ohio (Non-Hybrid)
Terms: W2, Full Time, Hourly, 40 hours/week
Hours: Daytime, Monday–Friday, including Holiday coverage
Proposed Start: August 3, 2026
Salary/Benefits: $20-24/hour DOE
Who We Are:
Located in Ohio, Access Advantage (www.accesselite.com), a Post-Acute Provider Network, offers managed care contracting, credentialing, performance, and payment services. Since 2008, we have helped more than 85 Ohio nursing homes fulfill their managed care goals. Our members are typically 100-bed skilled nursing facilities with strong local ownership and excellent performance. We aim to deliver customized, consolidated administrative services that support our Members’ success. Service is our forte.
About This Role:
The Managed Care Operations Coordinator provides administrative and operational support across managed care authorizations, payer contracting, provider enrollment, credentialing, and network management activities for Access Advantage and its Member facilities.
This role serves as a key liaison between skilled nursing facilities, therapy providers, managed care organizations, and internal teams to ensure authorizations, contracts, enrollments, and payer relationships are managed accurately and efficiently. The position requires strong organizational skills, attention to detail, and the ability to manage multiple projects simultaneously while maintaining compliance with HIPAA and regulatory requirements.
Essential Duties and Responsibilities:
Authorization Management
- Collect, organize, and submit clinical documentation for insurance pre-certification and recertification requests.
- Coordinate authorization requests for Medicare Advantage, Commercial, and Medicaid Managed Care plans.
- Submit documentation through payer portals including Availity, Carelon, Cohere, NaviNet, and other payer systems.
- Monitor authorization status and follow up with payers to ensure timely approvals.
- Communicate with facility and therapy teams regarding documentation requirements and authorization outcomes.
- Maintain accurate tracking logs and reporting for authorization activity.
- Assist with authorization reconsiderations, appeals, and payment recovery efforts.
- Support implementation activities for new Member facilities and managed care programs.
Contracting and Network Administration
- Assist with payer contracting activities for Access Advantage's skilled nursing facility network.
- Coordinate contract renewals, amendments, terminations, and implementation activities.
- Maintain contract databases, fee schedules, and payer contact information.
- Track contract effective dates, renewal timelines, and required follow-up actions.
- Prepare reimbursement analyses, contract summaries, and comparison reports.
- Support payer negotiations through research, data collection, benchmarking, and presentation materials.
- Monitor payer communications and distribute updates to internal stakeholders and network facilities.
- Maintain network participation records and provider directories.
Enrollment and Credentialing Support
- Process Managed Care payer enrollments.
- Coordinate revalidations and credentialing updates as required by payers.
- Maintain enrollment records and monitor application status through completion.
- Resolve enrollment-related issues impacting reimbursement and claims processing.
- Collaborate with revenue cycle teams regarding enrollment, credentialing, and contracting concerns.
Reporting and Administrative Support
- Prepare weekly, monthly, and ad hoc operational reports.
- Track authorization volumes, contract status, credentialing activities, and payer performance metrics.
- Assist with development and maintenance of policies, procedures, workflows, and training materials.
- Maintain accurate records in accordance with organizational standards and regulatory requirements.
- Support special projects and strategic initiatives as assigned.
Candidate Requirements:
- Associate's or Bachelor's Degree in Healthcare Administration, Business Administration, Health Information Management, or related field preferred.
- Minimum 3 years of experience in healthcare administration, managed care operations, payer contracting, credentialing, provider enrollment, authorization support, or related healthcare field.
- Experience working with Medicare, Medicaid, Medicare Advantage, and Commercial insurance plans.
- Knowledge of skilled nursing facility operations and post-acute care reimbursement.
- Experience utilizing payer portals such as Availity, Cohere, Carelon, NaviNet, or similar systems.
- Strong organizational and project management skills.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities and deadlines simultaneously.
- Proficiency in Microsoft Office, including intermediate Excel skills.
- Working knowledge of HIPAA and healthcare compliance requirements.
Preferred Qualifications:
- Experience in managed care contracting or provider network administration.
- Knowledge of SNF managed care reimbursement methodologies.
- Experience with credentialing and provider enrollment processes.
- Familiarity with claims adjudication, denials management, and reimbursement analysis.
- Understanding of contract language, fee schedules, and payer policies.
- Experience supporting managed care organizations, provider networks, therapy providers, or skilled nursing facilities.
- Knowledge of ICD-10, CPT, and healthcare billing terminology.
Success Factors
- The ideal candidate is highly organized, detail-oriented, analytical, and comfortable managing both operational and administrative responsibilities in a fast past environment. This individual demonstrates strong follow-through, effective communication skills, the ability to scope project and due dates and the ability to build productive relationships with facilities, payers, and internal stakeholders while ensuring timely completion of authorizations, contracting activities, and enrollment processes.
Pay: $20.00 - $24.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Experience:
- Managed Care: 3 years (Required)
Ability to Commute:
- Columbus, OH 43235 (Preferred)
Work Location: In person
