Deputy Director of Claims Systems Operations
Company: MetroPlus Health Plan
Location: New Haven
Posted on: January 10, 2021
|
|
Job Description:
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 OverviewUnder the general direction of the Associate
Executive Director of Claims, the Deputy Director is responsible
for the coordination of all operational management activities
related to the processing systems, system upgrades and work flows
of claims operations. The Provider File Maintenance operations unit
as well as the Claims Analyst will report directly to this
position. The position involves working closely with the leads for
the Claims Operations team, Claims Processing, Claims Service and
Medicare Claims Operations as well as Information Technology, Core
Systems Operations, Contracting and Network Provider Relations. In
conjunction with the Associate ExecutiveDirector of Claims, the
incumbent will develop and execute initiatives to enhance existing
functions and evolve support of corporate/department processes and
requirements.Job Description* Direct the operations of Provider
File Maintenance* Coordination of claims system activities with the
CORE Systems Director* Direct the claims systems testing and audits
to ensure continuous operations* Advise on process restructuring
activities and optimization of work groups around complex claim
processing issues and edits.* Maintain and track open issues and
coordinate process solutions* Identifies and resolves operational
issues using well defined/documented processes, expertise and
judgment.* Participate on various forums, company initiatives, and
other internal/external workgroups to provide oversight for issues
related to claim system operations* Collaborate with other
MetroPlus business groups to develop, document and standardize
procedures and workflows to support operational improvement.* Act
as a consultant for senior management on systems operation,
recommend changes for system design, methods, procedures and
workflows affecting claims operations* Leverage existing technology
by identifying opportunities to automate manual processes and
identify opportunities to incorporate new technology into processes
and flows.* Performs other independent duties and projects as
assigned.Minimum Qualifications* Bachelor's Degree or equivalent
work experience required* 3-5 years of management experience with
demonstrated success in managing operations* 2-3 years claim
management experience* Extensive knowledge of claims processing
systems; DST systems preferred* Experience in implementing claims
systems and peripheral systems* Testing interfacing upgrade
modules* Thorough knowledge and experience of procedures and
guidelines in claim processing* Strong client focus, that centers
around advocacy and seamless client experiences* Organization, time
management, planning and project management skills, ability to
manage multiple priorities to meet deadlines.* Ability to think
both tactically and strategically in addressing issues
resolutions.* Ability to create/analyze reports and utilize data to
drive results.* Ability to plan workflows effecting one or more
departments, and exercise initiative and judgment as well as make
decisions within the scope of assigned authority.* Demonstrates
leadership abilities with business units using appropriate
influencing and consensus building skills to manage expectations
and cultivate relationships.* Ability to manage multiple projects
and tasks.* Excellent interpersonal, verbal and written
communication skills.* Proficiency in Microsoft Office
ProductsProfessional Competencies* Integrity and Trust* Customer
Focus* Functional/Technical skills* Written/Oral Communication
Keywords: MetroPlus Health Plan, New Haven , Deputy Director of Claims Systems Operations, Executive , New Haven, Connecticut
Click
here to apply!
|
Didn't find what you're looking for? Search again!
Other Executive Jobs14G Air Defense Battle Management System Operator Description: Defend the skies using complex technology as an Air Defense Battle Management System Operator for the Army National Guard. You will primarily be responsible for integrating, operating, and maintaining (more...) Company: Army National Guard Location: Troy Posted on: 01/21/2021 Engineering Director Description: Equivalent ExperienceDescription:RESPONSIBILITIES: Will manage a large POM department Manage all facets of the organization including full P L responsibility and controlling assets with operating revenue, (more...) Company: Aerotek Location: Bronx Posted on: 01/21/2021 Senior Assistant Director Description: We're still hiring - In an effort to keep you and our staff safe, we are conducting virtual Zoom interviews in lieu of in-person At Samaritan Daytop Village, we serve over 33,000 New Yorkers annually (more...) Company: Samaritan Daytop Village Location: Ellenville Posted on: 01/21/2021 Marketing Manager Description: Job Title: Marketing ManagerBased In: Troy, NYQualifications: SEO, B2B Marketing, SalesforceSalary: 80 -100k, Full Benefits, 401k, etc.Based in Troy, we provide software for job boards, associations, (more...) Company: Optello Location: Troy Posted on: 01/21/2021 Mechanical Manager Description: If you are a General Manager - Mechanical Construction with experience, please read on Top Reasons to Work with Us Competitive compensation based on experience Excellent benefits package Great company (more...) Company: Optello Location: New Britain Posted on: 01/21/2021 Sr. QMS Project Manager Description: Look--for more--than answers.--Patients and--Physicians--rely on our diagnostic testing, information and services to--help them--make--better healthcare decisions. These are often serious--decisions with--far--reaching (more...) Company: Quest Diagnostics Location: Teterboro Posted on: 01/21/2021 Customer Relationship Management Manager Description: Top Prospect Group is seeking a CRM Application Manager who will be responsible for the implementation of an enterprise CRM solution in the White Plains area.The position will lead a team responsible (more...) Company: Top Prospect Group Location: White Plains Posted on: 01/21/2021 Senior Manager Business Solutions Description: About the Role:Heineken USA is embracing technology to deliver our ambition faster than ever, in an environment of accelerating technology trends. This role helps make that a reality, by delivering great (more...) Company: The HEINEKEN Company Location: White Plains Posted on: 01/21/2021 Program Manager (HAC246) Description: Volunteers of America-Greater New York VOA-Greater New York is the local affiliate of the national organization, Volunteers of America, Inc. and is one of the largest providers of human services in (more...) Company: Volunteers of America Greater New York Location: Clifton Posted on: 01/21/2021 Post-Acute Care Medical Director Description: Post-Acute Care Medical Director in Montgomery, AL Job Description br br Further your career providing compassionate patient care as a full-time, family medicine, internal medicine or geriatric Medical (more...) Company: TeamHealth Location: Montgomery Posted on: 01/21/2021 |