Senior Medical Payments and Fee Schedule Analyst Job Ref 104157 Category Professional Department CLAIMS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $75,000.00 Salary Range $75,000.00 $84,091.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care

The Inpatient/Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for physician documentation, clinical evidence that supports the d

The Claims User Acceptance Tester (UAT) will be responsible for validating whether all the business requirements have been fulfilled before releasing the actual product to production. The individual will perform positive and negative testing to identify and ensure any defects found are corrected prior to implementation. The Claims UAT will develop and follow a test plan w

The Claims Supervisor is responsible for the daily oversight of claims processes including but not limited to the inquiry and resolution process, adjudication process, user acceptance testing and quality assurance, training, and reporting. In addition, the position assists the claims manager with claims related queue management (i.e. claims, inquiries, refunds, adjudicati

As a Claims Adjustment Specialist I, this individual will be responsible for analyzing standard to complex post paid healthcare claims that require in depth research to determine accuracy and mitigate payment errors. The Claims Adjustment Specialist I will also be responsible for adjusting medical claims that result in overpayment or underpayment due to claim processing s

Under the direction of the Team Lead and Care Manager, the Health & Wellness Advisor I (HWA I) is a member of a team that provides care management services to our high risk Medicaid members to ensure the promotion of their health and wellness. As an integral team member, the HWA I will work in conjunction with the Care Manager to ensure the member receives Comprehensive o

Senior Director of Behavioral Health Strategy Job Ref 105750 Category Behavioral Health Department BEHAVIORAL HEALTH HARP Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $200,000.00 Salary Range $200,000.00 $216,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting com

Responsible and accountable to the Chief Medical Officer for helping to manage health plan medical quality, utilization, and assuring appropriate health care delivery, the Senior Medical Director serves in a policy, operational and strategic capacity. The Senior Medical Director overall purpose is to work across medical management functions, with a focus on Utilization Ma

Senior Director of Medical Directors Job Ref 102619 Category Utilization Review and Case Management Department UTILIZATION MANAGEMENT Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Salary Range $340,000.00 $350,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities thro

Claims Quality Auditor is responsible for reviewing claims to determine if payments have been made correctly. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon benefit configuration, compliance with provider contract agreements, and Federal, State a

MuleSoft Solution Architect & Manager Job Ref 105687 Category Information Technology Department INFORMATION TECHNOLOGY Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $170,000.00 Salary Range $170,000.00 $180,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting commun

Under the supervision of the Director of Clinical Case Management in the Behavioral Health HARP department, the Behavioral Health (BH) Care Manager Team Lead is responsible for the supervision of Care Managers (CM) within the BH Mainstream CORE Unit including coordinating daily operations and overseeing case management. The BH CM Team Lead monitors the CM departmental ACD

Sales Representative I Manhattan Job Ref 105665 Category Sales Department FACILITATED ENROLLMENT Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $50,000.00 Salary Range $50,000.00 $50,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We be

Educational/Enrollment Process Educate and provide assistance to qualified individuals with applying for coverage through the NY State of Health Marketplace in a Qualified Health Plan (QHP) and insurance affordability programs such as Medicaid and Child Health Plus. Assist consumers/applicants with calling the NY State of Health Customer Services Department for assistance

The primary function of the Quality Management (QM) Health Navigator is to outreach members missing important health screenings (i.e., HEDIS/QARR gaps in care) to assist in coordinating needed appointments for a variety of clinical and social services and ensuring maintenance medications are filled regularly. The QM Health Navigator will serve as a source of empowerment f