Upvote
Downvote
Director of Claims Quality Analytics
Share Job
- Suggest Revision
Full-time
- MetroPlus Health 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.
- Furthermore, the Director of Claims Quality Analytics is responsible for the management/oversight of claims quality, claims compliance, training and remediation, user acceptance testing (UAT), claims adjustments, and correspondence/inquiries/reconsiderations/appeals.
- Build a high-performance environment and implement a people strategy that attracts, retains, develops, and motivates their team by fostering an inclusive work environment, using a coaching mindset and behaviors, communicating vision/values/business strategy, and managing succession and development planning for the team.
- Coordinate with Compliance/Regulatory on DOH/DFS complaints and audit results, ensuring timely resolution.
- Collaborate with the Director of Payment Integrity to identify opportunities for financial recoveries and to ensure integrity of claims payments.
Active Job
Updated 30 days agoSimilar Job
Relevance
Active