Medicare Care Managment Team Lead (RN) Job Ref 96281 Category Utilization Review and Case Management Department CASE MANAGEMENT PROGRAM Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Salary Range $100,000.00 $110,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities th

Vice President of Business Transformation Job Ref 104258 Category Professional Department OFFICE OF THE COO Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $215,000.00 Salary Range $215,000.00 $230,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities throu

Senior Director of Customer Service Job Ref 104260 Category Call Center Department CALL CENTER Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $185,000.00 Salary Range $185,000.00 $200,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We b

Manager of Claims Business Process Monitoring Job Ref 102920 Category Claims Department OFFICE CORPORATE COMPLIANCE Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $100,000.00 Salary Range $100,000.00 $115,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communiti

The Director of Claims Quality has responsibility for the creation, delivery, and ongoing facilitation of a data and metrics driven Claims Quality Assurance and Performance oversight program, which includes defining frameworks/benchmarks, calibration, and reporting of a program towards set benchmarks while promoting a continuous improvement culture. Furthermore, the Direc

The Salesforce Architect will lead efforts to adapt and Salesforce, offer support to our business and responsible for a wide variety of critical applications built on Salesforce platform. The Salesforce Architect will also provide oversight and responsibility for the performance and operation of the Salesforce Development team through management, leadership, and mentorshi

Claims Relationship Representative Job Ref 104172 Category Claims Department CLAIMS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $50,000.00 Salary Range $50,000.00 $55,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that He

Vice President of Program Management Job Ref 104144 Category Professional Department MHP PMO Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $200,000.00 Salary Range $200,000.00 $226,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We bel

The Inpatient/Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for physician documentation, clinical evidence that supports the d

The Claims User Acceptance Tester (UAT) will be responsible for validating whether all the business requirements have been fulfilled before releasing the actual product to production. The individual will perform positive and negative testing to identify and ensure any defects found are corrected prior to implementation. The Claims UAT will develop and follow a test plan w

The Claims Supervisor is responsible for the daily oversight of claims processes including but not limited to the inquiry and resolution process, adjudication process, user acceptance testing and quality assurance, training, and reporting. In addition, the position assists the claims manager with claims related queue management (i.e. claims, inquiries, refunds, adjudicati

As a Claims Adjustment Specialist I, this individual will be responsible for analyzing standard to complex post paid healthcare claims that require in depth research to determine accuracy and mitigate payment errors. The Claims Adjustment Specialist I will also be responsible for adjusting medical claims that result in overpayment or underpayment due to claim processing s

Under the direction of the Team Lead and Care Manager, the Health & Wellness Advisor I (HWA I) is a member of a team that provides care management services to our high risk Medicaid members to ensure the promotion of their health and wellness. As an integral team member, the HWA I will work in conjunction with the Care Manager to ensure the member receives Comprehensive o