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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.
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Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
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Experience in key areas of healthcare payer or provider operations, CMS Risk Adjustment and HCC coding process and quality including Medicare Star Ratings and HEDIS. This role is responsible for supporting Cigna Medicare Advantage risk adjustment prospective programs, solutions, and performance in aligned operational region serving as a liaison between Markets and Provider Performance Enablement teams, Provider Education, and the Risk Adjustment Operations teams.
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Maintain compliance in all aspects of work. The role requires expertise in areas that include performance management/analytics, data exchanges, electronic medical record systems, provider workflow and processes, health information management, risk adjustment operations (particularly on the prospective side), value-based care, ICD-10, CPT and HCPCS coding principles and guidelines, and population health management.
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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.
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Provide a positive customer service experience - Maintain a current diary on outstanding claims - Prepare large loss reports as needed - Meet or exceed objectives for reserving standards, quality audits, closing ratio, expense controls, Medicare compliance - Maintain all adjuster licenses by attending CE courses as required - Perform other duties assigned.
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Care Plans, Electronic medical records, Health records, Medicare, Medicaid, Care management, Data Governance standards (manage, maintain, enforce vs define, create, capture), agile (jira, Rally, etc), data tools such as Snowflake, Tableau, Collibra, Infosphere.
ExpandApply NowActive JobUpdated 2 months ago - UpvoteDownvoteShare Job
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The Customer Experience Department is responsible for the timely retention, recertification and securing of the active membership within MetroPlus Health Plan. The member Experience Concierge is responsible for assisting members with their recertification process/applications in person and/or by phone.
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The Medicare Sales Representative is involved with health education through the distribution of health ed. In addition, the Medicare Sales Representative provides Facilitated Enrollment, helps facilitate the continuance of health insurance, and offers assistance with recertification.
$59,012 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Develops and maintains current knowledge of state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, managed long term care as well as contractual requirements.
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Medicare 2540 Cost Report for Post-Acute Care facilities. Medicare 224 Cost Report for Federally Qualified Health Centers (FQHC) Assist in the preparation of Medicare & Medicaid Rate Analysis.
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Arranges for direct provision of services such as homemaker, home health aide, public assistance, Medicare, Medicaid, emergency cash relief, legal aid, protective services, vocational placement, medical and psychiatric examination and therapy, housing, etc.
Full-timeExpandApply NowActive JobUpdated 15 days ago - UpvoteDownvoteShare Job
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Qualified candidates will have prior LTSS or Medicare Inpatient Utilization Management experience within a Managed Care setting, LTSS, MLTC MAP, will have a NYS Registered Nurse License , familiar with MCG/Milliman/Interqual Guidlines and a desire to join a great team.
$102,000 - $107,000 a yearFull-timeRemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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About NYC Health + Hospitals Metro Plus 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, Metro Plus Gold, Essential Plan, etc.
$150,000 - $157,236 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Job Responsibilities The Provider Network Development Specialist will have the following responsibilities: Develop mutually acceptable set of goals and objectives for provider recruitment in key NY communities by product line offering (e.g. Medicaid, Medicare, ACO REACH, PACE, MAPP/DSNP, MSO) Maintain a comprehensive list of network targets for outreach and leads that will drive success and market penetration.
$85,000 - $95,000 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago
medicare job Title: compliance specialist Company: Metroplus Health Plan in Woodside, NY
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