MetroPlusHealth 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, MetroPlusHealth 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position OverviewThe Director of Provider Contract Configuration is responsible for evaluating operation processes and procedures for process improvement of MetroPlusHealth Core Applications. Will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing.
Job Description- Oversee development and implementation of short/long term business objectives
- Direct and support initiatives to focus on projects with plan wide benefit in accordance with corporate budgetary objectives
- Ensure provider contracts are configured timely and accurately
- Oversee functions performed by delegated vendor(s) as it relates to benefit configuration, claims processing, provider setup and account payable system
- Manage activities and communications between key business stakeholders and Core System Vendor for implementation of new systems and optimization of current systems
- Develop and oversee SDLC methodology, including business requirements creation and sign-off, Quality
- Assurance, User Acceptance Testing, Production and Postproduction activities
- Address operational matters by working with business units to identify system solution to operational issues
- Participate and advise in new business/operational initiatives
- Provide guidance on current and future system capabilities
- Identify areas of operational improvement, promote strategic relationships with business areas, vendor, governmental and partner organizations
- Work with provider reimbursement tools, collaborate with Claims Operations, Utilization Management, and Network Management to setup pricing methodologies
- Facilitate improvement of the payment transaction process by interacting with providers and finance team
- Manage project implementation of upgrades and new products as it relates to Core Systems
Minimum Qualifications- Bachelor's Degree from an accredited college or university in Information Systems, Computer Science,
- Healthcare IT or related field
- A minimum of 10 years Data Processing related experience
- Healthcare IT experience required
Professional Competencies
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication
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