Provider Network Reimbursement Analyst
Company: Metroplus Health Plan
Location: New York
Posted on: June 25, 2022
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Job Description:
Empower. Unite. Care.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.About NYC Health +
HospitalsMetroPlus 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: Responsible for
investigating and resolving high level claims-related issues and
possess deep understanding an various reimbursement
methodologies.Job DescriptionImproves the level of engagement
between the Plan and Hospital Network, Ancillary and Community
providers by providing timely resolution of issues and providing
outstanding customer service and supportDetailed understanding of
various reimbursement methodologies (i.e., skilled nursing
facilities, medical group, post-acute bundles, etc.,) Conducts
audits to review accuracy of cost reports and payment of
claimsReviews inquiries from providers regarding cost report
settelementsResearches and analyzes claim processing outcomes,
identifies issues and reports as necessary, and proactively
outreaches to peers, supervisor, and/or providers upon
findingsPrepares and analyzes cost/business proposals and reports
of findings; makes recommendations to managementApplies knowledge
of established procedures to research and resolve escalated
customer questions or management requestsActs as the initial
contact for escalated issues from the support staff and escalates
only the most complex isues to the immediate supervisorLiasies
between Finance, Network Operations, claims, UM, Provider
Maintenance, Core and Contracting departments to resolve ongoing
issues and determines root cause and ultimately, resolution of
issuesReviews system setup to determine if it reflects contract
language and outreaches to the Contracting Department for
assistanceAttend Joint Operating Committee meetings and takes
ownership of resolving issus with assigned hospitals,
etc.Contributes to development of policies and procedures, process
improvement initiativesPerforms other support activites and duties
as assigned Minimum QualificationsRequires a Bachelor's degree3-5
years experience in a managed care government program claims
processing/analyzing experience, working with providers in
addressing reimbursement issuesAbility to work independently to
meet deadlinesWorking knowledge of and proficiency with
Windows-based PC systems and Microsoft Word, Outlook, Excel, and
PowerPoint, SharepointAbility to exercise tact and diplomacy and
demonstrate strong customer service skillsAbility to prepare
written and oral reports and make effective presentationsAbility to
independently manage assigned workload, make decisions related to
area of functional responsibility, and recognize issues requiring
escalationHighly organized, detail oriented, dependable and
professional individualAbility to travel to meet with Providers and
their representativesProfessional CompetenciesIntegrity and
TrustCustomer FocusFunctional/Technical skillsWritten/Oral
Communication
Keywords: Metroplus Health Plan, New York , Provider Network Reimbursement Analyst, Professions , New York, New York
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