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37 Jobs
Senior Director of Claims Managed Care
MetroPlus Health PlanRussell, IA
Oversee and provide direction with the Director of Claims Manage the relationship with the TPA/BPO for claims processing. Oversite of claims process of delegated vendors including but not limited to the TPA, dental vendor, vision vendor and other vendors for which claims is outsourced.
Full-time
Contracting Administrator
MetroPlus Health PlanRussell, IA
About 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.
jobsearcher.com/articlesClaims Analyst Certificate
If they have all of their information lined up and they are certified with Tricare, the PCA will pay out the claim
We promise to know you and help youJob Description:The Revenue Cycle Senior is part of a team that participates in various Healthcare Revenue Cycle projects.
Behavioral Health Claims Service Correspondent
MetroPlus Health PlanRussell, IA
The incumbent works closely with Provider Relations, Medical Management, Member Services and the Claims Processing unit. Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., claims, utilization management) Manage and ensure appropriate follow-up and closure for all inquiries.
Quality Control / Quality Assurance Analyst
Metroplus Health Plan IncRussell, IA
Position Overview This QA Analyst will be responsible for reviewing the Claims Processing Systems for configured benefits, and reimbursement methodologies. Experienced candidates must demonstrate working understanding of claims processing systems and working knowledge of the health care industry.
Senior Claims Call Center Representative
Metroplus Health Plan IncRussell, IA
Provides assistance, guidance, and on-the-job training to the claims call center representatives. Position Overview MetroPlus Health Plan is looking for an experienced problem solver to join the claims Call Center Team as a Senior Call Center Representative.
Claims Quality Manager
MetroPlus Health PlanRussell, IA
Job Description: Job Description About 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.
jobsearcher.com/blog
10 Reasons HR is Important to an Organization

"Nothing we do is more important than hiring and developing people."

MetroPlus Health Plan: Senior Director of Claims
MetroPlus Health PlanRussell, IA
Direct and oversee all Claims Department functions including front end processing, adjustments, special pricing, recoupments, claims complaints, claims correspondence, benefit configuration, audit and testing.
Director of Casualty Claims
MetroPlus Health PlanRussell, IA
Position Overview Under the general direction of the Claims Director/Senior Director, the Behavioral Health Medical Claims Manager's task is to ensure consistent oversight of Behavioral Health Claims and Medical Claims.
Claims Pricing Examiner II
MetroPlus Health PlanRussell, IA
Education and experience equivalent to 2 years of college education, 3 - 5 years of claims processing adjudication experience, preferably in a managed care setting. Thorough knowledge of claims processing regulations, systems, and procedures, preferably in a managed care setting.
Manager of BH Medical Claims & Compliance
MetroPlus Health PlanRussell, IA
Position Overview Under the general direction of the Claims Director/Deputy Director, Manager of BH Claims and Compliance's task is to ensure consistent oversight of Behavioral Health Claims and Medical Claims.
jobsearcher.com/blog
7 Importances of Organizational Culture and How to Build It

The world of work has drastically changed in the past few years. Where a good salary and a nice office might have been enough to attract talent in the past, employees today expect flexibility, growth opportunities, and a healthy work environment. In fact, 77% of applicants say they’d consider a company’s culture before applying for a job. 

MetroPlus Health Plan: Senior Director of Claims - Enhanced Salary
MetroPlus Health PlanRussell, IA
Monitor claims inventory, cycle time processing and work quality to assure conformity with corporate objectives and goals. Oversee the testing and auditing of claimsManage the claims correspondence with providers and membersMinimum QualificationsBachelor’s degree or equivalent combination of education and work experience.
MetroPlus Health Plan: Manager of Bh Medical Claims
MetroPlus Health PlanRussell, IA
Expected to be the subject matter expert on Behavioral Health and Medical claims processing rules and guidelines. Bachelor’s degree requiredExperience working in a managed care organization, medical /behavioral claims processing, and knowledge of regulatory requirements affecting medical/behavioral claim outcomes.
Director of Provider Contract Configuration
MetroPlus Health PlanRussell, IA
Will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing. 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.
Behavioral Health Claims Service Representative
Metroplus Health PlanRussell, IA
Work with the management team to stay updated on claims processing criteria, regulatory updates, new benefits and/or products and be informed of any changes in company policies. Experience with claims processing systems / applications.
jobsearcher.com/blog
Collaborative Recruiting: The Key to a Better Talent Acquisition Strategy

Talent acquisition is a multi-stage process where candidates undergo various application steps before getting hired. The unfortunate reality is that it is a labor-intense system, with the hiring manager and recruiter often handling all of the work on their own. Ask any one of them, and you will hear about the overabundance of applications and the demanding task of filtering through them to find the best candidates. The quality of talent suffers under the weight of all that work on one person's hands. It's not easy, but as many companies are starting to realize, there is a better way. The future of talent acquisition lies in collaborative recruiting!

Senior Director of Claims
MetroPlus Health PlanRussell, IA
Position OverviewThe Senior Director of Claims has overall responsibility and accountability for effectively and efficiently leveraging staffing and technology in delivering the claims processing and claims service for MetroPlus Health Plan. The position will direct strategic analysis and accuracy of the claims process and ensure compliance with regulations andcontract requirements for Medicare, Commercial, Exchange and Medicaid service lines.

claims claims processing jobs Company: metroplus health plan in Russell, IA

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