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
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.
Duties & Responsibilities- 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
- Bachelors' Degree, preferably in health care administration, marketing, or a related area of study
- 3-5 years' experience in a managed care or provider organization or,
- An equivalent combination of performing provider training/education and experience in related fields can be substituted for educational requirements
- Experience in behavioral health field, preferred
- Ability to travel within the MetroPlus service area
- Working knowledge of and proficiency with Windows-based PC systems and Microsoft Word, Outlook, Excel, and PowerPoint
- Ability to exercise tact and diplomacy and demonstrate strong customer service skills
- Ability to prepare written and oral reports and make effective presentations
- 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 travel to meet with Providers and their representatives
Professional Competencies
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication