Job description

Marketing Statement

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 Overview

The Provider Configuration Analyst will be responsible for the configuration of MetroPlusHealth’s systems to ensure that claims are processed according to Provider contracts.

Job Description

Configure provider reimbursement and create and maintain fee schedules
Apply technical and business knowledge to analyze departmental requirements needed to develop long and short-term plans.
Ensure system processes and services are aligned with the department’s need.
Analyze the system to ensure claims are processed correctly to prevent the company from liabilities.
Collaborate with MetroPlusHealth’s system consultants to correct errors, rectify omissions, and investigate questionable issues.
Identify potential system problems for claims resolution.
Analyze business processes, gather the requirements, and document the requirements in line with the strategic initiative
Review test cases making sure they are in accordance with requirements and assist the overall testing process.
Conduct ongoing reviews of systems and processes to ensure accurate and optimum setup for both provider and claims.
Attend meetings with managers regarding process plans, functionality, and business processes
Receive, coordinate, and manage requests for Systems Modifications
Maintain and track open issues and coordinate releasing testing
Document policies and procedures
Ability to run reports utilizing sequel
Create and maintain an inventory of pricing templates and their contents
Monitor and manage Core Systems performance
Respond to escalated issues from various MetroPlusHealth Departments.
Perform and assist with any other functions as required by the Director of Core Systems Operations
Participate in special projects as needed

Minimum Qualifications

A Baccalaureate Degree from an accredited college or university; and
Five (5) years of progressive, responsible experience in configuration for data processing, computer systems and applications; or
A satisfactory equivalent combination of training, education, and experience.

Professional Competencies