The purpose of the Newborn Coordinator is to assure Kaiser Permanentes newborns with Medicaid line of business receive timely enrollment and services to promote health. The Newborn Coordinator is responsible for ensuring enrollment, PCP assignment, authorization of services (in-network and out-of-network), and resolution of claims payment for Medicaid newborn enrollees.

• Research the eligibility of a newborn when Kaiser Permanente Medicaid line of business assignment is in question and confirm eligibility for the provider.
• Collaborate with case managers on the facilitation and confirmation of a primary care provider (PCP) selection for a newborn whose PCP assignment is in question, including retroactive PCP enrollment when necessary.
• Serves as primary resource to providers, enrollees, enrollment brokers, the state of Maryland Department of Health and Mental Hygiene, and newborn coordinators of other Managed Care Organizations on all questions related to newborn enrollment, authorization of care and services.
• Support the enrollment process, care coordination, authorization of services (in-network and out-of network), and resolution of claims payment payment for newborn enrollees.
• Responsible for verifying assignment of a newborn whose parent is enrolled in Kaiser Permanentes Medicaid line of busines, and newborns who are enrolled or auto assigned after birth.
• Reviews and resolves with the Maryland Department of Health and Mental Hygiene and enrollment brokers any eligibility or benefit clarification issues.
• Coordinates and communicates the request with the appropriate department (Kaisers membership accounting) of a Kaiser HealthChoice ID card.
• Reviews all newborn claims that are held for payment. Resolves outstanding issues for held claims, communicating with physicians, facilities, ancillary providers, enrollees and other departments/organizations as indicated during research to resolve claim held status.
• Performs other related duties as directed.

• Minimum two (2) years of experience with health plan authorization and referral processing required.
• Minimum two (2) years experience working with in collaboration with internal and external stakeholders of a healtcare organization required.

• Bachelors degree required

• N/A

• Knowledge of medical terminology, ICD-9/10 and CPT coding required.
• Ability to communicate effectively with external and internal providers required.
• Ability to work independently and manage multiple priorities required.
• Proficiency in the use of applicable computer software required.

• Minimum one (1) year experience claims audit.
• Bachelors degree in a healthcare-related field

PrimaryLocation : Maryland,Hyattsville,New Carrollton Administration
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:30 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-MAS-01|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : QA, UR & Case Management
Department : New Carrolltn Admin - UR-Case Mgmt-Ob - 1808
Travel : No
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.