Medical Payments and Fee Schedules Analyst
Job Ref: 45506
Location: New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $60,000.00
Salary Range: $60,000.00 - $70,000.00
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.
Responsible for analysis of medical payment rates and fee schedules. Work with a multidisciplinary team to interpret existing and develop new fee schedules and payment rates for medical services. Perform research to aid in the development of a base fee schedule. Perform financial modeling, impact analysis and audits on variations in medical payments. Serve as subject matter expert in all areas of fee schedules/groupers, rate reimbursement, and payment methodologies. Develop workflows and business processes to ensure timely and accurate interaction with Contracting, Network Relations, Claims, Core Configuration and other related areas. Act as facilitator to aid in the translation of contract payment terms into the core processing system. Fully comprehend the downstream impact of loaded rates within the Plan’s entire claims reimbursement cycle.
- Perform analysis of medical payment rates and fee schedules
- Ensure fee schedules are loaded according to the provider contract, including audit of implemented contracts
- Responsible for the identification, correction, and root cause analysis of fee schedule load and reimbursement problems
- As MetroPlus moves to more value-based reimbursement, ensure the impact on fee schedules and reimbursement methodologies are implemented appropriately
- Serves as subject matter expert with all contract implementation for fee schedule, rate reimbursement matters, and payment methodologies.
- Analyzes negotiated contracts to ensure that interaction with the core systems is aligned with negotiated intent
- Participate in rate testing with all impacted teams within the Plan.
- B.S. degree in Business, Finance, Economics, Information Systems or equivalent.
- Master’s Degree a plus, but not required.
- Minimum 3-5 years of relevant experience, preferably in a health care environment.
- Strong familiarity with health plan claims/provider billing systems and interdependent applications.
- Experience in data and auditing functions.
- Experience in developing and improving business process
- Analytic, problem solving, technical skills and attention to detail are required.
- Strong analytical skills and attention to detail
- Excellent understanding of contracts, especially in a provider and payer relationship
- Knowledge of CMS, New York State Medicaid, and third-party fee schedules, as well as industry wide payment methodologies, and claims edit policies.
- Excellent communication and documentation skills
- Ability to multi-task
- Ability to translate business process requirements into a production environment
- 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