Business Process SpecialistMetroPlusHealth • New York, NY, United States
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Business Process Specialist
MetroPlusHealth • New York, NY, United States
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job_description.job_card.job_descriptionRequires a Bachelor’s degree; and 3-5 years experience in a healthplan; Medicaid plan a plus; or A satisfactory equivalent combination of education, training, and experience. Good understanding of provider network management and health system hierarchy set up at a health plan General understanding of provider network contract terms, Medicare fee schedules, CPT / HCPCs codes General understanding of claims adjudication at a high level; Health Edge / HRP experience a plus Good compend of Salesforce; experience at a health plan setting a plus Integrity and Trust Customer Focus Highly organized, detail oriented, dependable and professional individual
Position Overview
MetroPlus Health is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
This position will ensure a successful migration to Health Edge / Health Rules Payer (HRP) core system for Provider Network Operations (PNO). This role will be part of cross functional and multi-departmental work groups, representing PNO, in the deployment of HRP, representing our priorities and workflows.
Duties & Responsibilities
- Support migration to a new core claim system (Health Rules Payer or HRP) for Provider Network Operations team (PNO)
- Attend all needed HRP meetings through a phased roll out by product which includes prep, testing and post go live meetings
- Maintain PNO issue tracker for HPR project for PNO Leadership
- Assist in HRP project issue resolution impacting Providers
- Assist in updating HRP or general PNO process documents, policies and / or desktop procedures for PNO as needed
- Prepare executive summaries and / or communication materials to convey HRP changes or updates
- Represent PNO VP or Director at HRP or other operational meetings as needed
- Work on other critical PNO projects as needed
- Assist in provider data quality assurance between CACTUS, PowerStepp, HRP and Salesforce through migration timeline and beyond as programs sunset.
- Monitor provider complaints related to HRP migration and prioritize for appropriate work groups and / or war rooms.
- Responsible for data collection, data extraction, data analysis, and data reporting activities related to HRP migrations and PNO issues
- Act as liaison between the Credentialing, Provider Maintenance, and Customer Service departments and investigate and respond to inter-departmental project-related inquires related to HRP or general PNO work as needed.
- Performs other support activites and duties as assigned
Minimum Qualifications
Professional Competencies
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Specialist • New York, NY, United States