Job Description

Leader, Government Programs & Integrated Health Claims

Headquarters Office, 625 State Street, Schenectady, New York, United States of America Req #1296

Friday, October 21, 2022

Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it's time to make a healthy career move to MVP!

There are some positions at MVP where your work may require an onsite or community component. When working in an MVP office and/or in the community on behalf of MVP, you must be fully vaccinated against COVID-19, and have received the first booster dose within one month of eligibility.

Full-Time, Exempt

Position is Hybrid

The Leader will be responsible for delivery of operational excellence in the Medicare, Medicaid, HARP, Child Health Plus and Essential Plan lines of business and Integrated Health supporting all lines of business., Develops and administers performance standards as well as activities such as improvement and optimization of processes. Ensure that all claim inventory received is accurately adjudicated and in a timely manner. Additional responsibilities include working with various departments within MVP to ensure excellent value-added services for our customers. The Leader is required to have a strong background and knowledge of all CMS Medicare and Medicaid regulations. Monitors operational performance and proactively addresses issues. Builds and fosters relationships with other departments in problem solving concerning claims operations to proactively resolve claim errors/issues and drive efficiencies. Leading business requirements and working closely with technical resources to develop automated solutions such as scripting.Provide direct oversight of claims processing activities with the objective of meeting production, timeliness and quality standards. Provide coaching/feedback to establish high performing teams including addressing employee departmental issues as needed. Participates in meetings and supports successful implementation for assigned projects using good judgement and decision-making. Successfully Lead the dedicated processing team that support the integration of health care.The Leader will be required to develop monitoring for new regulations and be responsible for reviewing and approving data provided in support of regulatory reporting requirements.Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time. Performs other related duties as assigned.

POSITION QUALIFICATIONS

Minimum Education:
BA Degree or AS Degree a plus. 4+ years of demonstrated work experience may be substituted.

Minimum Experience:
Minimum of 3 years claims adjudication in health insurance and Minimum of 3 years management experience

Required Skills:

Knowledge of ICD-10, CPT-4, HCPCS coding, DRG

Claim Processing knowledge including Medical, Behavioral Health & Substance Abuse services

Strong proficiency in problem solving and analysis- ability to interact with all levels of management

Ability to make decisions related to content for CMS Universe and Plan Data Validation Audits for CMS

Content expert in CMS & NYS audits and take lead in webinar demonstration

Adaptability and flexibility in a changing environment required

Ability to use Excel, Microsoft Office, Power Point

Solid understanding of Medicare regulations, Medicaid regulations and Affordable Care Act Regulations

Excellent follow up skills

Excellent verbal and written communication skills

About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at [email protected]

Please apply and learn more - including how you may become a proud member of our team.

Other details

• Job Family Claims/Operations
• Pay Type Salary

Apply Now

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• Headquarters Office, 625 State Street, Schenectady, New York, United States of America

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