MetroPlus Health Plan
Product Implementation Specialist
MetroPlus Health Plan, New York, New York, us, 10261
Product Implementation Specialist
Job Ref:
112893
Category:
Professional
Department:
MHP PRODUCT
Location:
50 Water Street, 7th Floor,New York,NY 10004
Job Type:
Regular
Employment Type:
Full-Time
Hire In Rate:
$75,000.00
Salary Range:
$75,000.00 - $85,000.00
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
MetroPlus Health
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, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health
has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position Overview
The Product Implementation Specialist will use their benefit and Product knowledge to prepare, monitor, and customize benefit changes or payment reimbursement requirements per regulatory guidance. They ensure a smooth benefit implementation based on the request from start through completion. To ensure this happens, they talk with internal business owners, collect data, customize required configuration forms, define objectives, and maintain corporate tracker. The Product Implementation Specialist will act as the point of contact for the company and initiate implementation processes as quickly as possible.Job Description
Lead the regulatory implementations for NY State-Sponsored Programs and CMS Medicare lines of business.Manage the full project cycle of implementations from beginning to end.Analyze complex Product benefit configuration and rate implementation projects and build a range of meaningful recommendations.Use data and insights to inform conclusions and support decision making.Proactively gather information to understand business owner needs.Effectively communicate with all business partners including Core Systems, Medical Management, Business Operations, Regulatory and Compliance ensuring appropriate and timely updates to any potentially impacted departments.Review and verify documentation for compliance and operational accuracy.Assist with CPT code verification for benefit implementations ensuring proper configuration.Special projects and other related duties as assigned.Minimum Qualifications
Bachelor's Degree required.Minimum 5 years of experience in health care, medical coding, product, regulatory, or other relevant field.Medical coding experience preferred.Project Management skills preferred.Working knowledge of Product department, implementations, system transformation and operational aspects of health careExperience or in-depth knowledge of HealthRules Payor system is a plus.Skills in Microsoft Excel, PowerPoint, and Word are requiredLicensure and/or Certification RequiredMedical Coding Certification preferredProfessional CompetenciesIntegrity and TrustCustomer FocusExcellent verbal, written, mathematical, and interpersonal skillsAble to work collaboratively and efficiently with multidisciplinary teamsHighly detail-orientedStrong presentation skills#LI-Hybrid
Job Ref:
112893
Category:
Professional
Department:
MHP PRODUCT
Location:
50 Water Street, 7th Floor,New York,NY 10004
Job Type:
Regular
Employment Type:
Full-Time
Hire In Rate:
$75,000.00
Salary Range:
$75,000.00 - $85,000.00
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
MetroPlus Health
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, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health
has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position Overview
The Product Implementation Specialist will use their benefit and Product knowledge to prepare, monitor, and customize benefit changes or payment reimbursement requirements per regulatory guidance. They ensure a smooth benefit implementation based on the request from start through completion. To ensure this happens, they talk with internal business owners, collect data, customize required configuration forms, define objectives, and maintain corporate tracker. The Product Implementation Specialist will act as the point of contact for the company and initiate implementation processes as quickly as possible.Job Description
Lead the regulatory implementations for NY State-Sponsored Programs and CMS Medicare lines of business.Manage the full project cycle of implementations from beginning to end.Analyze complex Product benefit configuration and rate implementation projects and build a range of meaningful recommendations.Use data and insights to inform conclusions and support decision making.Proactively gather information to understand business owner needs.Effectively communicate with all business partners including Core Systems, Medical Management, Business Operations, Regulatory and Compliance ensuring appropriate and timely updates to any potentially impacted departments.Review and verify documentation for compliance and operational accuracy.Assist with CPT code verification for benefit implementations ensuring proper configuration.Special projects and other related duties as assigned.Minimum Qualifications
Bachelor's Degree required.Minimum 5 years of experience in health care, medical coding, product, regulatory, or other relevant field.Medical coding experience preferred.Project Management skills preferred.Working knowledge of Product department, implementations, system transformation and operational aspects of health careExperience or in-depth knowledge of HealthRules Payor system is a plus.Skills in Microsoft Excel, PowerPoint, and Word are requiredLicensure and/or Certification RequiredMedical Coding Certification preferredProfessional CompetenciesIntegrity and TrustCustomer FocusExcellent verbal, written, mathematical, and interpersonal skillsAble to work collaboratively and efficiently with multidisciplinary teamsHighly detail-orientedStrong presentation skills#LI-Hybrid