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MetroPlus Health Plan: Deputy Director of Claims Systems Operations

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MetroPlus Health PlanQueens Village, NY
  • Job DescriptionAbout NYC Health + Hospitals MetroPlus 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 Under 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 Executive Director of Claims, the incumbent will develop and execute initiatives to enhance existing functions and evolve support of corporate/department processes and requirements.
  • 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.
  • 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 Products Professional Competencies
  • Integrity and Trust
  • Associated topics: administrative coordinator, administrative staff, administrative support, assistant, beverage, document, facilities, food, operation, records management

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