Business Process Specialist

Job Ref: TE0003
Category: Professional
Department: Provider Network Operations
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Salary Range: $68,000.00 - $78,000.00

Position Overview

MetroPlusHealth 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

• Requires 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

Professional Competencies

• Integrity and Trust
• Customer Focus
• Highly organized, detail oriented, dependable and professional individual

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