Director of Provider Contract Configuration - Brooklyn, United States - MetroPlus Health Plan

MetroPlus Health Plan Brooklyn, United States

1 week ago

Description

Director of Provider Contract Configuration

Job Ref: 105818

Category: Information Technology

Department: INFORMATION TECHNOLOGY

Location: 50 Water Street, 7th Floor,

New York,
NY 10004

Job Type: Regular

Employment Type: Full-Time

Hire In Rate: $150,000.00

Salary Range: $150, $165,000.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

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 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.
A minimum of 10 years of healthcare systems experience such as process improvement, project management or system configuration.
Project Management and Staff Supervision a plus

Professional Competencies

Integrity and Trust
Customer Focus
Functional/Technical skills
Written/Oral Communication

#LI-Hybrid

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