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
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.
MetroPlusHealth 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, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
Responsible for analysis and loading of reimbursement rates and fee schedules. Work with a multidisciplinary team to interpret existing and develop new fee schedules and payment rates for Medical and Behavioral Health services. Perform financial modeling, impact analysis and audits on variations in reimbursements. Serve as subject matter expert in all areas of fee schedules, rate reimbursement, and payment methodologies. Develop workflows and business processes to ensure timely and accurate interaction with Contracting, Network Relations, Core
Configuration, Analytics, 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.
Professional Competencies
#LI-Hybrid