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 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.
Job Overview
Responsible for providing provider onboarding, training for claims and billing procedures, contract compliance, Product, medical management, and pharmacy issues. Promotes provider compliance with local/state/region/federal regulations through provider forums and training opportunities, inclusive of behavioral health network.
Job Description
Provide provider onboarding along with any on-going trainings either at provider sites or remotely.
Organize training schedules, tracking attendees, setting up classroom and practicum trainings, finalizing the training content and handouts, etc.
Supports and maintains current provider network through customer service including training, credentialing assistance, claims resolution and advocacy.
Develops and provides a standard orientation package for newly contracted providers.
Promotes technology and skills development to improve provider business practices.
Implement processes for documenting and monitoring training program for provider compliance and program effectiveness.
Ensure contract compliance and identify areas for improvement.
Participate in cross functional teams to solve system issues.
Other duties as required and assigned by management.
Minimum Qualifications
Bachelors’ Degree required, preferably in health care administration, marketing, or a related area of study; and
3-5 years’ of experience in a managed care or provider organization; or
A satisfactory equivalent combination of training, education, and experience performing provider training/education or work in a related field
Experience in behavioral health field, preferred.
Ability to travel within the MetroPlusHealth service area to meet with providers and their representatives
Working knowledge of and proficiency with Windows-based PC systems and Microsoft Word, Outlook, Excel, and PowerPoint
Professional Competencies
Integrity and Trust
Customer Focus
Functional/Technical skills
Ability to independently manage assigned workload, make decisions related to area of functional responsibility, and recognize issues requiring escalation
Highly organized, detail oriented, dependable and professional individual
Ability to exercise tact and diplomacy and demonstrate strong customer service skills
Ability to prepare written and oral reports and make effective presentations
#MPH-50
Department Preferences
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NYC Health + Hospitals is the nation’s largest public health care delivery system. We are an integrated network of hospitals, trauma centers, neighborhood health centers, nursing homes, and post-acute care centers. We are a home care agency and a health plan, MetroPlus. The health system provides essential services to more than 1.4 million New Yorkers every year in more than 70 patient care locations and in their homes. Our talented workforce of more than 40,000 represents the diversity of our city and the communities we serve. The excellence of our staff, and our continued mission to care for all without exception, make us unique and rightly positioned to provide equitable, high-quality, culturally responsive, and affordable health care in every New York City community.
Our promise to New Yorkers: Empower every New Yorker – without exception – to live the healthiest life possible by providing equitable, high quality, culturally responsive, and affordable health care in every community.
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 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.
Job Overview
Responsible for providing provider onboarding, training for claims and billing procedures, contract compliance, Product, medical management, and pharmacy issues. Promotes provider compliance with local/state/region/federal regulations through provider forums and training opportunities, inclusive of behavioral health network.
Job Description
Provide provider onboarding along with any on-going trainings either at provider sites or remotely.
Organize training schedules, tracking attendees, setting up classroom and practicum trainings, finalizing the training content and handouts, etc.
Supports and maintains current provider network through customer service including training, credentialing assistance, claims resolution and advocacy.
Develops and provides a standard orientation package for newly contracted providers.
Promotes technology and skills development to improve provider business practices.
Implement processes for documenting and monitoring training program for provider compliance and program effectiveness.
Ensure contract compliance and identify areas for improvement.
Participate in cross functional teams to solve system issues.
Other duties as required and assigned by management.
Minimum Qualifications
Bachelors’ Degree required, preferably in health care administration, marketing, or a related area of study; and
3-5 years’ of experience in a managed care or provider organization; or
A satisfactory equivalent combination of training, education, and experience performing provider training/education or work in a related field
Experience in behavioral health field, preferred.
Ability to travel within the MetroPlusHealth service area to meet with providers and their representatives
Working knowledge of and proficiency with Windows-based PC systems and Microsoft Word, Outlook, Excel, and PowerPoint
Professional Competencies
Integrity and Trust
Customer Focus
Functional/Technical skills
Ability to independently manage assigned workload, make decisions related to area of functional responsibility, and recognize issues requiring escalation
Highly organized, detail oriented, dependable and professional individual
Ability to exercise tact and diplomacy and demonstrate strong customer service skills
Ability to prepare written and oral reports and make effective presentations