Advanced Search
Title
Company
Description

Location:

Start New Search:

nyc health hospitals
non medical
340b
chargeback
deputy director
claims specialist
drg
market access
legal and compliance
tpa
bp
150k
claims processing
gp
queens
rebate
adjudication
ceiling
amp
bronx

Manager of BH Claims And Compliance at Metroplus Health Plan, Inc

Share Job
Suggest Revision
MetroPlus Health PlanNew York, NY
  • Position Overview Under the general direction of the Claims Director/Deputy Director, the Manager of BH ClaimsandCompliance's task is to ensure consistent oversight of Behavioral Health Claims and Medical Claims.
  • Oversee the performance and quality of claims outcomes to ensure adherence to all contractual and regulatory requirements Job Description Expected to be the subject matter expert on Behavioral Health and Medical claims processing rules andguidelines.
  • Serve as primary organizational contact for all behavioral health claims related issues.
  • Monitor and evaluate performance, and effectiveness of claims operations continuous, determine itseffectiveness, in meeting and/or exceeding contractual and regulatory requirements.
  • Manage claims operational reports for visibility into vendor performance trends.
  • Track, measure, report, and evaluate vendor performance.
  • Stay apprised of changes to contracted services, and oversight activities are performed while ensuring thebehavioral health vendor is aware of performance expectations and their own performance metrics.
  • As issues are identified, work with vendor to identify root cause and corrective action plans to avoid areoccurrence of the issue.
  • Oversee the behavioral health and medical claims quality assurance process.
  • Responsible for the oversight of the claims' compliance process.
  • Identify risks and implement plan to monitor and address risk related tasks.
  • Develop and implement a behavioral health and medical claims testing and auditing process.
  • Perform ongoing monitoring of the claims process to ensure claims are processed accurately and arecompliant with regulatory guidelines.
  • Document and report findings.
  • Conduct and/or participate in regular meetings, telephone calls and formal vendor communications andnotifications.
  • Minimum Qualifications Three plus (3+) years of vendor management, contracts, and relationship management experience.
  • Bachelor's degree required Experience working in a managed care organization, medical /behavioral claims processing, andknowledge of regulatory requirements affecting medical/behavioral claim outcomes.
  • Industry knowledge: Understands behavioral health/medical claims processing guidelines, and haveknowledge of local, state, and federal health care regulations.
  • Performs all duties inherent in a managerial role.
  • Ensures effective staff training, evaluates staffperformance, provides input for the development of the department budget, and hires, promotes, and terminates staff, as appropriate.
  • Skilled at directing and motivating others.
  • The ideal candidate will be able to flex his/her style and direct, collaborate or empower others as the situation requires so that the plans goals are met.
  • This leadership position must establish and maintain productive relationships with multiple stakeholders, with internal and external stakeholders.
  • Excellent customer/client service aptitude.
  • Flexible and adaptable in handling and implementing change.
  • Must be a self-motivated individual who grasps concepts quickly, takes proactive ownership of task or processes and is a team player.
  • Ability to manage multiple projects/tasks in a dynamic environment with minimal direction, prioritize, and multitask independently.
  • Detail oriented with analytical proficiency, able to navigate ambiguous situations, investigative thinking.
  • Excellent written and verbal communication skills with the ability to effectively communicate and interact with all levels of personnel within the organization, including presenting information and responding to questions from groups of managers, clients, customers, and the public.
  • Extensive knowledge across different functional areas.
  • Proficiency in Excel require.
  • Other duties, as assigned.
  • Salary Range: $80K
  • 150K *Minimum QualificationAuditing & Compliance, Banking, Loans & Insurance

Similar jobs:

Active
  • All Jobs
  • Active
Senior Manager, Pricing And Contracting
Axsome Therapeutics, IncNew York, NY
Reporting to the Director, Strategic Pricing & Contracting, this individual will interact with internal colleagues within Market Access and cross functionally with Executive Leadership, Finance, Legal and Compliance and Brand teams.
$200 - $250
Vice President of Claims Operations
MetroPlusNew York, NY
About NYC Health + Hospitals
$200 - $250
Claims Specialist
VNS HealthNew York, NY
The Claims Specialist adjudicates claims for all product lines of VNS Health Plans.
Vice President of Claims Operations
MetroPlusHealthNew York, NY
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.
Full-time
Claims Specialist
Visiting Nurse Service of New YorkNew York, NY
Overview The Claims Specialist adjudicates claims for all product lines of VNSNY CHOICE. Performs root cause analysis for all provider projects to identify areas for provider education and/or system (re)configuration.
$125 - $150 Full-time
jobsearcher.com/blog
How do Good Interviewers Prepare for Interviews?

Just like candidates take the time to research you and your company, you should take the time to prepare for the interview. Preparing for the interview doesn't just reflect well on your employer brand and create a better candidate experience. Preparation also helps prevent bad hiring decisions. Bad hiring decisions are usually a result of poor execution during the hiring process. However, going into an interview fully prepared and ready to evaluate candidates will help avoid bad hires. So, here are 6 interview preparation tips for employers.

Health Care Claims Examiner
MJHSBrooklyn, NY
Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs.
Full-time
RN Executive - VP of Care Management - MLTC
Compass Healthcare Consulting And PlacementManhattan, NY
Opportunity for VP of National Care Management Operations for Delegated Care Management Program.
Full-time
Head of Product Compliance
TransferWiseNew York, NY
Background: The Global Head of Product Compliance is a strong leader and compliance subject matter expert across risk (e.g. finance, treasury, capital requirements), regulation, financial crime, and other domains.
Claims Operations Manager - National Remote
UnitedHealth GroupNew York, NY
Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (8:00am - 5:00pm CST).
Remote
jobsearcher.com/blog
What is Talent Mapping

Every planner and recruiter knows that each strategic process requires a pre-strategic process. This is usually just the pre-planning phase of your master plan. Because hiring and recruiting involves many aspects of business (budgets, time, employees, planning, etc.), it is important to ask yourself a few questions to evaluate what resources you have to fulfill your hiring needs. These questions include:

Senior Claims Analyst
Village CareNew York, NY
Job Description Senior Claims Analyst VillageCare is seeking an enthusiastic professional for our Full Time Senior Claims Analyst, which will ensure that Villagecare adjudicates claims accurately and timely in accordance with our policies and procedures and in compliance with NY State and CMS policies and regulations.
Consultant, Compliance - Health
Benz CommunicationsNew York, NY
The Opportunity: The Health Compliance Consultant (lawyer) reports to the Deputy Director of the Health Compliance Practice.
Consultant, Compliance - Health
The Segal Group, IncNew York, NY
The Opportunity: The Health Compliance Consultant (lawyer) reports to the Deputy Director of the Health Compliance Practice.
$150 - $200 Full-time
Senior Claims Analyst
LHHNew York, NY
Senior Claims Analyst
Full-time
jobsearcher.com/blog
What is a Policy of Non-Retaliation & How to Create One

Your company probably has many policies in place – anti-discrimination policies, equal opportunity policies, ethics policies, and so on. However, it is important to re-evaluate whether you have a policy that covers every situation. Say for instance one of your employees submit a complaint in good faith to their supervisor. To their surprise, they are met with retaliation, such as demotion, defamation, or even termination.

Murex Business Manager
AccentureNew York, NY
Accenture has been helping Murex clients transform their front, middle and back-office operations and risk management functions, including collateral management and treasury operations, for more than 20 years.
Full-time
Director of People & Culture
Kimpton Hotels & RestaurantsNew York, NY
He initiated a new boutique hotel standard and environment where people could connect, from the heart.

Latest Blog Posts:

jobsearcher.com/blogHow to Take Your Careers Page to the Next LevelYour careers page deserves a lot of attention. It is not just another page on your website. It is a vital tool that could enhance your recruitment outcomes. But in order to do that, you have to make sure it's fully optimized.
jobsearcher.com/blogWhen to Tell Your Boss You're Job SearchingThe Bureau of Labor Statistics has found that individuals, on average, have 12.4 jobs throughout their working life. So regardless of where you are on the career ladder, it’s inevitable that at some point, you’ll begin looking for another job. That said, you might be wondering
jobsearcher.com/blogWhat Questions Can You Not Ask in an Interview?It can be stressful to interview candidates to fill an open role at your company. Maybe your boss is on you to hire someone who’s absolutely perfect as soon as possible. Maybe you don’t have a ton of experience yet in conducting interviews. Whatever the case, there’s a lot to take under consideration when you’re the one in charge of interviewing. For instance, “What questions can you not ask in an interview?” may very well be running through your mind given its legal ramifications. Knowing exactly which interview questions are off-limits (and which are fine to ask) will boost your confidence as you continue to search for the ideal new hire. 
jobsearcher.com/blogHow to Practice Fair Chance Hiring for People With Criminal RecordsUsually when you think of your dream hire, you think of someone who is respectful, trustworthy, reliable, and has sound judgment, right? As you envision your ideal candidate with these qualities, the last person you think of is someone with a criminal record.
jobsearcher.com/blog6 Common Mistakes to Avoid When Employer BrandingCurrently, job searchers are putting extra effort into researching employers. The information they find plays a major role in whether they will pursue an opportunity with you or look for jobs elsewhere. That is why it is now more important than ever to be proactive and intentional when showcasing your workforce and workplace culture. Having a well crafted employer branding strategy can help you strategize and influence your potential candidates so they see your business in the best light. But in order to do that, you should be aware of some of the most common mistakes that employers make.
jobsearcher.com/blogWhat to Say When Terminating an EmployeeTerminating an employee is an inevitable part of doing business. Whether you’re re-structuring your department or you’ve identified a few employees who’re not living up to your expectations, letting people go is necessary for keeping your workforce healthy and thriving. 
jobsearcher.com/blogHow to Utilize Keywords for Your Job AdsBefore we give you the scoop on how to utilize keywords in job ads, it would be helpful if we defined what keywords are and why they are important. In simple terms,