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BPO Relationship Manager

Job Ref: 46323
Category: Professional
Department: MEDICARE - GENERAL SERVICES
Location: New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $80,000.00
Salary Range: $80,000.00 - $80,000.00

Marketing Statement

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview 

The purpose of this position is to solidify current relationships, build new business relationships where necessary and generate business opportunities at the same time. The qualified candidate for this position will build strong relationships with partners and clients and using interpersonal skills to network in an effective way. In addition, the qualified candidate implements information technology in support of solidifying these relationships. The position will also require interfacing with the departments listed below. The incumbent will ensure the delegated contractor is meeting 100% of the services outlined in the contract and is MetroPlus’ single point of contact for the relationship. When gaps in service provided by the contractor are identified, the incumbent will lead cross functional teams to ensure the gaps are corrected expeditiously.

Job Description

  • Serve as Product Operations central point of contact between MetroPlus internal areas and BPO.
  • Collaborate with MHP compliance and BPO to operationalize CMS, NYSoH changes
  • Collaborate with BPO to ensure all required notifications and/or action sets are developed in Market Prominence including:
    • defining triggers and validations
    • defining sequence for serial letters
    • Timeframes for letter generation
  • Collaborate with BPO to ensure benefits structures are configured appropriately in PowerStepp.  Includes 
    • New benefits 
    • Benefit changes/corrections
  • Collaborate with BPO to test business and functional processes related to system upgrades, member correspondence, and operational changes
  • Collaborate with BPO configuration support to develop automated business processes 
  • Respond to escalated issues related to enrollment entry
    • Escalation point between MHP and BPO for issue related to:
    • CMS file submission and/or failure
    • Fee schedule updates/issue
    • Claims processing issues related to benefit setup
    • EOB issuance
  • Liaise between MHP operation units and BPO to resolve issues
    • Marketing 
    • Customer Service
    • Medicare and Marketplace Operations
    • Finance
    • Core Systems
    • Compliance 
    • IT-MIS
  • Monitor BPO operational activities resulting from corrective action plans initiated by internal and/or CMS audits
  • Communicate and collaborate with internal stakeholders (including but not limited to Product Operations, Marketing, Communications, Network and Medical Management, Claims and Compliance as needed to support overall MetroPlus quality and customer experience objectives
  • Review data extracts to research and monitor timely processing related to enrollment and claims activity
  • Monitor and review CMS updates for changes that may impact operational processes related to BPO
  • Coordinate between MetroPlus internal areas and the vendor to monitor open cases, eligibility data loads, audit activities and implementations (benefit configuration, program changes, provider/claims configurations, member correspondence, etc).
  • Coordinate with BPO to conduct annual readiness reviews and gather appropriate attestations. 
  • Other adhoc reports as requested
  • Coordinate efforts with BPO to create new user accounts
  • Coordinate efforts with BPO to reset MP server passwords
  • Perform all other duties as assigned.

Minimum Qualifications

  • 3-5 years vendor management experience
  • 3-5 years of managed care experience 
  • Bachelors Degree in Finance, Accounting, Business, Science, Economics, or related field. Masters preferred
  • Ability to work independently with minimal supervision
  • Competent at relationship-building. Focuses on understanding the needs of the client and getting the best possible results
  • An ethic of client service, an understanding and anticipation of a client’s changing needs
  • The ability to manage stress and conflict, keeping composed and acting as a mediator when conflicts arise
  • Using interpersonal and communication skills to network in an effective way
  • Picks up on the need to change personal, interpersonal, and managerial behavior quickly
  • Is sensitive to changing personal demands and requirements and changes accordingly
  • Uses his/her time effectively and efficiently
  • Concentrates his/her efforts on the more important priorities
  • Good analytical skills and ability to prioritize diverse responsibilities
  • Proven ability to learn appropriate software
  • Effective problem solving and analytical skills are required with the ability to evaluate demands on time and resources effectively
  •  Ability to work with all resource levels within the organization.
  • Required to take annual Medicare training

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication

How To Apply

If you wish to apply for this position, please apply online by clicking the "Apply Now" button or forward your resume, noting the above Job ID #, to:


MetroPlus Health Plan
Human Resources Department
160 Water Street 8th Floor
New York, NY 10038
Attn: Recruitment Unit

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