MVP Health Care jobs

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a **Clinical Investigator** to join #TeamMVP. This is the opportunity for you if you have a passion for problem solving and investigations, commitment to compliance and ethical standards and dedication to continuous learning and improvement. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work For in the NY Capital District** , one of **the Best Companies to Work For in New York** , and an **Inclusive Workplace** . **Qualifications you'll bring:** + BA/BS degree in criminal justice or a related field, and minimum of five years of insurance claims investigation experience; or five years of professional investigation experience with law enforcement agencies, or seven years of professional investigation experience involving economic or insurance related matters. + A clinical investigator must have in addition to the above requirements: A duly licensed or authorized medical professional, including but not limited to MD or RN. + New York State Nursing license required (RN preferred). Experience in health insurance fraud investigations preferred. + Obtain CPC and/or COC credential. + Maintain nursing license and coding credentials through continuing education process as required. + Superior judgment skills, verbal and written communication, and presentation skills. + Extremely detail-oriented with excellent organizational and analytical skills. + Ability to utilize various data management tools to help identify potentially fraudulent activity. + Possess knowledge of CPT-4, ICD-9-CM, ICD-10-CM, HCPCS and CPT Assistant coding guidelines as they relate to claim data. + Working knowledge of MS Office (Word, Excel and Outlook) + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction **Preferred Job Skills:** + Working knowledge of Macess, Facets, CareRadius, Cognos, CMS web sites, and Encoder-Pro. **Your key responsibilities:** + Conduct clinical reviews of various forms of medical documentation and records obtained from providers and facilities including but not limited to medical charts, patient account records, and member interviews. + Organize and conduct highly complex investigations. Document findings and recommendations throughout the investigative process in a timely and efficient manner according to corporate and departmental SIU policies and procedures. + Act as an SIU liaison and interact with and analyze data in cooperation with Pharmacy, Medical Affairs, Operations, Provider Relations, Credentialing, Customer Care Center, Legal and other corporate personnel. + Assist in investigations conducted by government agencies, law enforcement, and other insurance company SIU staff. + Make recommendations for and conduct clinical re-audits of providers and facilities previously audited by SIU. + Testify in criminal and civil legal case proceedings as necessary and assist outside legal counsel especially concerning issues needing clinical decision making. + Participate in annual Corporate FWA training and training of new SIU personnel. + Keep abreast of Federal and State Anti-Fraud investigation and reporting requirements including HIPAA, CMS, Medicare, Medicaid, and any corporate compliance initiatives or policies. + Minimal travel may be required pertaining to investigations and audits. + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** Virtual; Must reside within Eastern or Central Time Zone \#CS **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** . **Job Details** **Job Family** **Compliance** **Pay Type** **Salary** **Hiring Min Rate** **69,383 USD** **Hiring Max Rate** **80,000 USD**

Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member's needs, health goals and mitigate health care cost drivers. Essential Accountabilities Level I Handles physical health member clinical management programs. Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable. Carries out job responsibilities in accordance with departmental, corporate, state, federal and accreditation standards, as well as licensure, certification and scope of practice requirements for each specific health-related field/specialty, Maintains confidentiality and conducts information management procedures per corporate and departmental policy. Implements the Case Management Process per department policies, procedures and guidelines. The process includes case identification, case opening, member assessment, education and support intervention opportunities, developing care plans, conducting member-centric interventions, measuring member outcomes during re-assessment, case closure, and case reviews. Screens members that fall within the defined populations served, referred to the department, either by data analysis or by internal or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management services. Initiates case management, as outlined in the Case Management Program Description. Opens appropriate cases timely and effectively. Using motivational interviewing, assures essential information relating to case management is disclosed to members, thus increasing the opportunity for success in meeting member health goals. Works in collaboration with members' physicians and other health care providers to assess the needs of the member, facilitate development of an interdisciplinary care plan, coordinates services, evaluates effectiveness of services and modifies the member care plan as necessary. Maintains positive working relationships within this arena. Assesses member/caregiver knowledge of his/her illness and initiates appropriate education interventions to address knowledge deficits. Collaborates with member/caregiver to determine specific objectives, goals and actions to address member needs and barriers to meeting health goals identified during assessment. Provides appropriate resources and assistance to members with regards to managing their health across the continuum of care. Maintains updated information related to appropriate community resources and serves as a source of information for providers and other members of the healthcare team. Acts as a liaison between providers and community resources. Participates in inter-disciplinary coordination and collaboration to ensure delivery of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory Therapist Accepts responsibility for continuing education relative to professional growth. Meets or exceeds the minimum continuing education requirements as set forth by departmental and corporate policy, and by individual professional certification standards, if applicable. Participates in and promotes other health plan programs, such as, Preventive Health, use of web-based tools for self-management of conditions and engagement in digital health programs and applications. Work collaboratively with all Case Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and coordination of care. May work with internal and external stakeholders for value-based payment programs, such as accountable cost and quality arrangements (ACQA). Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. May participate in the orientation of new staff. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II (in addition to Level I Essential Accountabilities) Handles all member clinical condition management programs. Offers process improvement suggestions and participates in the solutions of more complex issues/activities. Mentors junior staff and assists with coaching whenever necessary. Consistently meets/exceeds all productivity and performance metrics, including positive results of audits. Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health. Manages more complex assignments and/or larger caseloads. Displays leadership skills and serves as a positive role model to others in the department. Participates in the orientation of new staff. Level III (in addition to Level II Essential Accountabilities) Process Management and Documentation Identifies, recommends, and evaluates new processes as necessary to improve productivity and gain efficiencies. Assists in updating departmental policies, procedures and desk-top manuals relative to the CM functions. Identifies and develops processes and guidelines for performance improvement opportunities for the Case Management Department. Expert and resource for escalations. Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems. Mentors and provides guidance and leadership to the daily activities of the Case Management Department clinical staff. Acts as resource to Case Management staff, members, and providers. Provides backup for the Supervisor/Manager, whenever necessary by: Participating in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care. Acting as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit (SIU), Provider Relations (PR), or Sales & Marketing. Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and educational needs to address established policies and procedures and job responsibilities. Minimum Qualifications NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels Associates degree required. Bachelor's degree preferred. Active NYS RN or Registered Dietician or Physical Therapist licensure required. Minimum of three (3) years of clinical experience required. Case Management experience preferred. Must demonstrate proficiency with the Microsoft Office Suite. Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred. Strong written and verbal communication skills. Ability to multitask and balance priorities. Must demonstrate ability to work independently on a daily basis. Deliver efficient, effective, and seamless care to members. For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within three (3) years of either hire and/or moving into this role supporting the FEP LOB. Level II (in addition to Level I Qualifications) A minimum of 2 years in case management position. Case Management Certification preferred. Delivers efficient, effective, and seamless care to members. Demonstrates ability to escalate to management, as necessary. Demonstrates proficiency in all related technology and documentation requirements. Consistently meets or exceeds all performance metrics. Level III (in addition to Level II Qualifications) Must have been in a current Case Management position or similar subject matter expert for at least 5 years. Case Management Certification required Broad understanding of multiple areas (i.e. UM and CM). At this level, incumbent is required to know multiple functional areas and supporting systems. Expertise in Case Management area and able to handle complex assignments, challenging situations, and highly visible issues. Ability to lead the training of new staff. Demonstrated presentation skills. Physical Requirements Ability to travel and work long hours on a computer. May require flexible hours to meet needs of member discussions. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I / E2: $60,410 - $96,081 Level II / E3: $60,410 - $106,929 Level III / E4: $65,346 - $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Based on the book of business associated with this opening, candidates must reside in the Rochester region. The Account Service Consultant ensures prompt, accurate, and efficient servicing of all Broker, Member, and Employer Group Administrator inquiries. Inquiries may be via telephone, email, written inquiries, and lobby walk-in's or through on-site visits with an employer group and/or broker. This role provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance Group & Broker satisfaction/retention. The Account Service Consultant maintains constant communication with the Sales staff and other Business Partners throughout the organization. Essential Accountabilities: Level I • Responsible for the implementation of new groups, renewals, and conversion of groups to new product lines. • Researches, interprets, and responds to inquiries from internal and external customers, business partners, brokers, consultants, and groups concerning our products, services, and policies in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements. • Responsible for custom, complicated employer group servicing. Partners with Sales to create and deliver presentations to external customers. • Manages any de-implementations associated with a complex group that terminates from our portfolio when applicable. • Reviews all group-facing documents and validates for accuracy. This can include, but is not limited to, benefit summaries, summary plan descriptions, Member Contracts, Group Agreements, etc. • Partners with Project Management team to support vendor relationships and conversations related to electronic enrollment methods for assigned book of business. • Acts as a liaison between the group/broker and internal departments when it comes to new group implementations and renewals. • Identifies and responds to issues brought forward either internally or externally and ensures all inquiries will be responded to within 24-48 hours - same business day preferred where possible. Interacts with Operations, Enrollment and Billing, Customer Care, Claims, Advocacy, Clinical Operations, Medical Affairs and Finance/Underwriting Departments to resolve identified issues. • Assures that all account data is maintained on a timely and accurate basis such as initial account setup, benefit books, summaries, contracts, etc. • Utilizes both standard and custom products in a manual workflow to meet the needs of clients. • Validates all group set up and renewal completions. • Completes and successfully passes training(s) to support job role/function. • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. • Regular and reliable attendance is expected and required. • Performs other functions as assigned by management. • Demonstrates willingness to adapt and be flexible to changes and business needs while taking ownership and accountability for issue identification and resolution. Level II (in addition to Level I Accountabilities) • Assists with on-the-job training of other Account Service and Sales Account Managers as requested. Support Level I team members with more complex issues. • Ongoing participation in meetings, training, and skill development to support career path and individual development plans. • Identifies issues, patterns and/or trends generated by external and internal action affecting customer satisfaction and consistently and independently recommends and initiates changes and improvement for process review. • Attends meetings and/or trainings as a representative of the Account Service Team and shares the information learned with the Account Service Staff within a reasonable timeframe • Handles HIPAA (Health Information Portability and Accountability Act) issues as requested by members through Group Administrators. Specifically, handles all Designated Record Set (DRS) requests and may serve as a point person for the Account Service team when difficulties arise in obtaining information through normal channels. Level III (in addition to Level II Accountabilities) • Assists with tasks assigned by management that require advanced problem-solving skills. • Partners with Sales to create and deliver presentations to external customers. • Mentors and trains more junior Account Service team members to initiate resolution to all outstanding and/or difficult issues. • Acts as a back up to Account Manager when individual is out of the office. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • In lieu of degree, 2 years of experience in service or healthcare industries. High School diploma or equivalent required. Associates Degree in related field preferred. • Valid NYS Accident and Health license within six months of employment required. • Familiarity with NYS and Federal regulations and underwriting policies and all process flows. • Strong oral/written communication and customer service skills. • Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment and remain professional and focused under multiple pressures and demands. • Ability to complete required internal Medicare Training per Center for Medicare Services within one year of start date. • PC skills essential: spreadsheet and word processing applications, database functions and sales force automation software applications. Level II (in addition to Level I Qualifications) • Two or more years of experience in a sales operation's environment. • Valid NYS Accident and Health license. • Knowledge of NYS and Federal regulations and underwriting policies and all process flows. • Demonstrated relationship building skills. Level III (in addition to Level II Qualifications) • Five or more years of experience in a sales operations environment. • Valid NYS Accident and Health license. • Proficient with NYS and Federal regulations and underwriting policies and all process flows. • Experience creating and delivering client presentations. • Excellent analytical/problem-solving skills. Physical Requirements: • Ability to travel within the Health Plan service region as necessary to offer support for on-site visits to groups/brokers, open enrollments, training, and/or off-site meetings. • Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I (N7) Minimum: $23.56/hr - Maximum: $37.70/hr Level II (N8 Minimum: $26.89/hr - Maximum: $43.03/hr Level III (N9) Minimum: $29.57/hr - Maximum: $47.32/hr The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Qualifications you'll bring: Bachelor's Degree in Business, Math, Computer Science, Information Systems, related field or five or more years of related work experience. Master's degree preferred. Minimum 3 years of analytics experience with large data sets required 1 year of analytics experience with healthcare quality data highly preferred Subject matter expertise in healthcare data- claims, coding, HIE's etc. Experience with quality metrics, (NCQA HEDIS and NYS QARR) standards strongly preferred Strong analytical skills, with the ability to turn data into actionable insights Proficiency in SQL, data visualization tools (e.g. Tableau, PowerBI) Data Manipulation tools (e.g. Alteryx, R, Python) beneficial Excellent verbal and written communication skills, with the ability to effectively communicate technical information to both technical and non-technical stakeholders Intermediate Excel skills include entering and editing complex formulas, filtering lists, sorting ranges, and using data analysis tools (pivot tables, scenarios, etc.) Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Lead and oversee the successful execution of quality data deliverables. Conduct analysis of large data sets to support quality improvement initiatives, including gap analysis, process optimization, and patient engagement. Collaborate with cross-functional teams to design, implement, and maintain data solutions that meet the needs of stakeholders and business partners. Ensure the accuracy and integrity of data through the development and implementation of data quality control processes and procedures. Must also provide adequate documentation of how analysis was performed and be responsible for applying necessary checks and balances to ensure quality and accuracy of reports. Participate in the development of data governance policies, standards, and procedures, and ensure compliance with regulatory requirements and industry best practices. Present data insights and recommendations to leadership, effectively communicating complex technical information to non-technical stakeholders using visual aids (charts, graphs) or summaries. Continuously monitor and evaluate the effectiveness of operational workflows, making recommendations for improvements and leading implementation efforts as necessary. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Virtual in NYS

Qualifications you'll bring: BFA or a BA/BS in Graphic Design, Marketing, Advertising, Communications or other relevant field preferred, or Associates Degree in Graphic Design with a portfolio or comparable work experience. The availability to work full-time, hybrid. Minimum of 6-8 years' experience designing print and digital assets in a corporate setting, with health care industry experience a plus. Ideal candidate will have experience as an in-house designer or at an ad agency designing for both business-to-business and business-to-consumer audiences. Work samples are required to apply for this position. Curiosity to foster innovation and pave the way for growth. Humility to play as a team. Commitment to being the difference for our customers in every interaction. Your key responsibilities: Design and develop a wide range of media including brochures, flyers, posters, ads, signage, direct mail, and digital assets (web, email, social media, presentations). Contribute to concept development and marketing design strategies that support member communications and acquisition/retention efforts. Champion the MVP Brand Guidelines to ensure every piece reflects a consistent look, tone, and feel. Stay current with design software and digital trends, embracing new tools and ways of working. Collaborate with internal teams and external vendors to manage projects from concept to completion - on time and on point. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Hybrid position, living within 50 miles from State Street in Schenectady or Rochester, NY.

The Dir Actuarial Service is responsible for supervision of staff in the routine operation of the Actuarial Services departments. This position leads healthcare cost trend and medical cost analysis, and financial forecasting and budgeting process for the health plan. The Director develops and provides actuarial and financial recommendations that protect the organization's financial integrity; information and recommendations provided must be sound and consistent to support target pricing margins, corporate goals, new initiatives and other complex measures related to financial solvency. The incumbent plays an active role in the preparation and interpretation of data and related formulae. The position utilizes national and local information sources ranging from industry publications and consultants to analysis of internal data and works effectively with a wide variety of internal staff, external vendors, and regulators. Essential Primary Responsibilities/Accountabilities: Builds new quarterly trend and forecasting process in collaboration with Health Care Network Management staff. Develops quarterly health plan financial forecast and necessary monthly analyses. Develops health plan financial budget. Coordinates financial forecast and budget development for all lines of business. Develops dental Reporting, small group pricing, and rate filings. Forecasts health plan margin strategy requirements. Trends model development and maintenance. Conducts trend analysis to support pricing, forecasting, and opportunity identification. Conducts Monthly Stop Loss reserve analysis and support. Develops seasonality analyses. Designs, implements and maintains medical expense trend models including cross-functional collaboration and information sharing. Ensures efficient use of SAS software in the development of data sets and models. Develops and maintains appropriate level of SAS expertise in the department. Identifies and manages departmental goals consistent with corporate objectives. Establishes individual annual performance goals for staff, guide staff in setting individual learning and development plans, assess individual performance, and determine merit, promotional and recognition salary increases and awards. Ensures efficient management of the department; promote continual process improvement. Mentors and develop staff to take leadership roles. Ensures consistent policies and procedures across regions. Takes a leadership role in representing the department on special projects. Identifies emerging issues that impact corporate, divisional or departmental goals. Notifies Information Management with regards to Data Warehouse integrity issues. Prepares and maintain documentation for routine procedures and special projects. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements. Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Minimum Qualifications: Bachelor's degree in Actuarial Science, Mathematics, Statistics or related field and eight years actuarial experience in a healthcare environment. Professional designations of Fellow of the Society of Actuaries and Member of the American Academy of Actuaries (MAAA) preferred. Minimum three years of experience in leadership role. Minimum of five years of experience in leadership role preferred. Advanced analytical skills. Advanced knowledge of financial and risk arrangements. Strong PC skills and proficiency in Microsoft Office. Strong verbal and written communication skills. Strong project and people management skills. Strong leadership skills. Ability to translate technical concepts into business language. Ability to design and implement process improvements. High integrity and interpersonal skills. High sense of urgency and accountability. High degree of independence, creativity and initiative. Level II - requires similar qualifications as Level I, plus: Minimum of ten years of actuarial experience. Physical Requirements: ************ One Mission. One Vision. One I.D.E.A. One you. Together we can create a better I.D.E.A. for our communities. At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know inclusion of all people helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating all of our employees' experiences, skills, and perspectives, we take action toward greater health equity. We aspire for our employees' interests and values to reflect the communities we live in and serve, and strongly encourage all qualified individuals to apply. OUR COMPANY CULTURE: Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing an inclusive workforce, innovative thinking, employee development, and by offering competitive compensation and benefits. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade D5: Minimum $137,857 - Maximum $248,143 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Qualifications you'll bring: Bachelor's degree of applicable study with minimum of 3 years of experience in Health Care Analytics role or Advanced degree in math or statistics, and at least 1 year of experience working with Health Care data Working knowledge of Provider Billing/Reimbursement methodologies Foundational knowledge of MVP's markets and products and awareness of competitive landscape Working knowledge of MVP Data assets including claim, pharmacy, member and provider data Proficiency in SQL and Microsoft suite of products including Power Platform Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Collaboration with team leader, peers and key stakeholders across the organization Research and query multiple data sources, manipulate large sets of data using appropriate tool Identify and implement the most efficient solution for the business problem with forward thinking mindset to leverage automation and efficiency Leverage AI, Machine Learning or Statistical software where appropriate to advance analytics Validation of data, data models and reporting for accuracy and soundness Actively seek to draw inferences from the data to drive actionable insights/strategic discussions Actively seek to understand the why and how to add value to business request vs. just doing the request Actively challenge the status quo and find a better way Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Location: remote within New York State

This pharmacist clinician is a program manager, who is responsible for all Medicare Part D formulary creation and submissions, which includes utilization management criteria development for the current and upcoming contract years. This individual creates and executes the Medicare Part D formulary, delivering value and quality to the Plan's Part D enrollees, while ensuring the longevity of the Plan's Part D program. Essential Accountabilities: Develops and maintains the Part D formulary in collaboration with strategic business partners, which include trade relations, finance, and sales to maximize savings, ensure quality, and minimize member disruption, while incorporating all CMS Part D guidance Manages all CMS Part D Formulary requirements to ensure deadlines are met. Works in conjunction with the Pharmacy Benefit Manager (PBM) and Formulary Management software vendor to execute on all formulary-related tasks. Collaborates with cross-functional management teams within the organization to align and prioritize Medicare objectives across the organization to ensure success within the framework of the Medicare STARS ranking system and deliver value to enrollees. Creates and operationalizes Medicare Part D criteria for all utilization management requirements in alignment with the Utilization Management Team. Obtains endorsement of the Medicare Part D formulary program elements from the Pharmacy and Therapeutics Committee. Oversees the production of CMS formulary model materials in partnership with Medicare Sales and Marketing. Works in conjunction with the outside vendor as needed to complete all formulary-related tasks. Supports and educates inter-departmental staff (clinicians, customer care, sales) and external customers (members, brokers) with respect to Part D formulary, utilization management edits, and CMS Part D program guidance, as appropriate. Reviews, formulates, and executes corrective action plans in conjunction with Medicare Compliance for all formulary-based findings. Supports and acts as subject matter expert for CMS formulary-based audits. Acts as a subject matter expert for clinical strategy initiatives designed to improve quality and affordability for Medicare beneficiaries. Contributes to clinical strategy initiatives within the Pharmacy Department and across the enterprise, which serve to improve quality and affordability for Medicare beneficiaries. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Minimum Qualifications: Unrestricted NYS Licensed Pharmacist. Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required with a minimum of three (3) years' experience in a managed care setting. Experience in Medicare Part D is strongly preferred. Expertise and background with Federal and state regulatory agencies (CMS, DOH, DFS, etc.) and/or accreditation agencies (NCQA, BCBSA) is preferred, but not required. Proficiency in Microsoft Excel preferred. Ability to articulate complex information in a manner that can be understood by various internal and external target audiences. Possesses the confidence to think and act differently. Demonstrates ability to thoughtfully challenge the status quo related to clinical and operational strategies and processes. Physical Requirements: Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer. Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. Ability to work in a home office for continuous periods of time for business continuity. Ability to travel across the Health Plan service region for meetings and/or trainings as needed. Ability to lift, carry, push, or pull 15 pounds or less. Manual dexterity including fine finger motion required. Repetitive motion required. The ability to hear, understand, and speak clearly while using a phone, with or without a headset. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Min: $98,297 - Max: $176,935 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ensuring compliance with internal and external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as required, to meet departmental time frames. Per department needs, may be responsible for additional hours. Essential Accountabilities: Level I Performs pre-service, concurrent and post-service clinical reviews to determine the appropriateness of services requested for the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient care delivery processes. Ensures compliance with corporate and departmental policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director. Utilizes appropriate communication techniques with members and providers to obtain clinical information, assesses medical necessity of services, advocating for members in obtaining needed services, as appropriate, interacts with the treating physician or other providers of care. Collaborates with hospital, home care, care management, and other providers effectively to ensure that clinical needs are met and that there are no gaps in care. Acts as a resource and liaison to the provider community in conjunction with Provider Relations, explaining processes for accessing Health Plan to perform medical review, obtains case or disease management support, or otherwise interacts with Health Plan programs and services. Makes accurate and consistent interpretation of required clinical criteria, medical policy, contract benefits, and State and Federal Mandates. May be responsible for pricing, coding, researching claims to ensure accurate application of contract benefits and Corporate Medical Policies. Accountable for meeting departmental guidelines for timeliness, production and metrics and meeting requirements established for audits to ensure adherence to regulatory and departmental policy/procedures. Maintains compliance with all regulatory and accrediting standards. Keeps abreast of changes and responsible for implementation and monitoring of requirements. Assists with training and special projects, as assigned. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) Offers process improvement suggestions and participates in the solutions of more complex issues/activities. Mentors staff and assists with coaching, as necessary. Provides consistent positive results on audits. Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health. Manages more complex assignments; cross-trained to review various levels of care and/or services. Participate in committees and lead when required Level III (in addition to Level II Accountabilities) Displays leadership and serves as a positive role model to others in the department. Identifies, recommends and assesses new processes to improve productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. Assists in updating departmental policies, procedures, and desk level procedures relative to the functions Expert and resource for escalations - Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems. Mentor (to others in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to Utilization Management staff, members and providers. Provides backup for the Supervisor, whenever necessary. Participates in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care. Assists Medical Director (MD) in projects as needed. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels Associates degree and active NYS RN license required. Bachelors degree preferred. Minimum of three years of clinical experience required. Utilization Management experience preferred. Must demonstrate proficiency with the Microsoft Office Suite Demonstrates general understanding of coding standards Maintains current and working knowledge of Utilization Management Standards. Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred. Strong written and verbal communication skills Ability to multitask and balance priorities. Must demonstrate ability to work independently on a daily basis. Deliver efficient, effective, and seamless care to members. Level II (in addition to Level I Qualifications) Minimum of 2 years in utilization management position. Demonstrates ability to escalate to management, as necessary. Demonstrates proficiency in all related technology Ability to take on broader responsibilities Ability to participate in training of new staff Level III (in addition to Level II Qualifications) Must have been in a utilization management position or similar subject matter expert for at least 5 years. Broad understanding of multiple areas (i.e. UM and CM). Incumbent is required to know multiple functional areas and supporting systems. Expert in Utilization Management and ability to handle complex assignments, challenging situations and highly visible issues. Ability to lead the training of new staff. Demonstrated presentation skills. Physical Requirements: Ability to travel across the health plan service regions as needed. Ability to work at a computer for prolonged periods of time. ************ One Mission. One Vision. One I.D.E.A. One you. Together we can create a better I.D.E.A. for our communities. At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know inclusion of all people helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating all of our employees' experiences, skills, and perspectives, we take action toward greater health equity. We aspire for our employees' interests and values to reflect the communities we live in and serve, and strongly encourage all qualified individuals to apply. OUR COMPANY CULTURE: Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing an inclusive workforce, innovative thinking, employee development, and by offering competitive compensation and benefits. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade E2: Minimum $60,410 - Maximum $96,081 Level II: Grade E3: Minimum $60,410 - Maximum $106,929 Level III: Grade E4: Minimum $65,346 - Maximum $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

This position is responsible for the delivery and availability of Health Plan regulatory documents through printing and display in all electronic mediums employed by the enterprise. The incumbent ensures compliance with federal and state regulations and BCBSA in delivery of key compliance documents including, but not limited to, Subscriber Contracts, Summary of Benefits and Coverage, Medicare regulatory documents, and other customer notifications regarding product and contract updates. Essential Accountabilities: Level I Responsible for coding and maintenance of the document production system. Configures the content and documents business rule script coding to the document requirements design specifications, tests content of business rule scripts to ensure accuracy and quality for each business rule script condition statement, creates testing scripts for both content and document testing, and identifies benefit data requirements to complete testing. Adheres to all regulatory requirements and internal controls. Creates the regulatory document requirements outlining the design structure, benefit field requirements, process flow specifications and business rule script coding configuration. Develops test scripts to ensure quality and compliance for documents available both in print and via online mechanisms. Responsible for developing strategy, gaining approval and documenting requirements for the maintenance of the document production system. Ensures regulatory documents are ready for print and issued within regulatory timeframes. Analyzes requests for mandates, benefit changes, and account specific changes to determine impact to existing document production system. Identifies and documents new processes and procedures related to document production with the introduction and implementation of new technologies or system upgrades. Works in partnership with Corporate Publishing/Document Services providing document project and application requirements for naming conventions, document formats and output composition. Works with internal areas to obtain clarification of product benefits coded in benefit systems. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) Leads document system configuration changes and new configuration requirements, including configuration analysis, design, build, test and documentation. Identifies, documents and works with internal staff on enhancements required to Stepwise/PCMS and the benefit XML to produce regulatory documents. Creates complex regulatory document production requirements. Determines time and resource needs and translates high level user and business requirements into detailed document configuration. Analyzes all group and product benefit and rate information support systems (e.g., Contract Development System, Stepwise, PCMS, Seibel, or membership systems). Manages implementation and mailing of group and member notices. Strategizes with management on best approach to implementing new documents or completing system maintenance. Acts in a consultative capacity to provide professional technical expertise in determination of suitable approaches to implementation and issuance of regulatory documents. Identifies and leads projects to implement approved process improvements and new technologies or system upgrades. Prepares and delivers necessary written and oral presentations. Coaches, mentors and trains less experienced team members. Oversees document system code development and production quality. Serves as the Regulatory Document Delivery system subject matter expert (SME). Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. Level I Four or more years of relevant business systems analysis experience or Associates Degree in Computer Science, Business Administration or other relevant field with two or more years' experience working in a technical environment. A combination of education and experience may be considered. Familiarity with State and Federal legislative mandates and BCBSA requirements. Knowledge and understanding of health insurance products with benefit detail, financial arrangements, and the Stepwise/PCMS, PEGA/SAHC or similar systems preferred. Demonstrated proficiency utilizing the tools and systems provided for regulatory document production. Detailed understanding of the functional process flows, XML structure and content, benefit systems, and document production systems. Ability to write and translate business and system requirements. Ability to identify root causes and workflow problems and determine innovative solutions and opportunities to meet process and production goals within compliance constraints. Excellent written communication skills including a minimum of two years' technical or business writing experience. Knowledge of standard project methodology and quality testing programs. Strong analytical ability and problem-solving skills. Ability to adapt and respond to the diverse and unexpected situations normally encountered in the marketing and service occupations and maintain professionalism and poise under pressure. Ability to prioritize assignments, work independently and handle confidential information with discretion is essential. Capable of establishing constructive relationships with internal staff of all levels. Ability to strategize with management staff. Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Teams, SharePoint and PowerPoint). Level II (in addition to Level I Qualifications) Six or more years of relevant business systems analysis experience and development and coding experience or Associates Degree in Computer Science, Business Administration or other relevant field with four or more years of relevant business systems analysis experience. Bachelor's degree preferred. Four years of progressive regulatory document delivery development consistently demonstrating accuracy and proficiency in creating document strategy, document requirements, and implementation for both standard and complex documents. Extensive knowledge and understanding of the Health Plan products, benefit detail, financial arrangements, and the Stepwise/PCMS, PEGA/SAHC systems. Demonstrated ability to independently manage the implementation of new and innovated documents in support the corporate strategies. Demonstrated ability to write and code business rule scripts and to interpret, define and apply content of the benefit XML. Demonstrated advanced proficiency in Microsoft Office Suite (Word, Excel, Teams, SharePoint and PowerPoint). Physical Requirements: Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer. Ability to travel across the Health Plan service region for meetings and/or trainings as needed. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I (E1): Minimum: $60,410 - Maximum: $84,000 Level II (E2): Minimum: $60,410 - Maximum: $96,081 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Qualifications you'll bring: Bachelor's Degree preferred; equivalent experience may be substituted if the candidate can demonstrate significant relevant work experience. Minimum of 5 years in health insurance or equivalent experience in Finance or Project Management. Strong proficiency in problem solving and analysis Ability to use Microsoft Office and Power Point Proficiency in Excel. Must be able to manipulate pivot tables, utilize mathematical formulas, filter data, etc. Excellent presentation skills Proficiency in financial impact analysis Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Coordinates with Analytics Team to generate performance reporting and associated financial models. Assists Leaders in leveraging of competitive transparency data during contract negotiation and annual performance reviews. Assists with developing contract documents for renewals and/or amendments in compliance with company templates, reimbursement structure standards and other key process controls. Supports the business relationships with Hospital, Physician and Ancillary Facilities. Maintains an inventory of contracts, due dates, term clauses/end dates, spend and services by LOB. Requests necessary data analytics from Informatics to support key business objectives and product objectives where contracting is involved. Keeps and maintains necessary database trackers and a tracking system for department and MVP report outs. Processes forms, tracks and scans signed/executed agreements and amendments. Serves as the primary point of contact for day-to-day issues such as payment issues, authorization issues and contractual language interpretation disputes. Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time. Proactive in identifying areas for efficiency improvement across all of Network Management; consistently challenges the status quo in favor of incremental improvement opportunities that could be achieved through new methods. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Location: Hybrid to Schenectady, NY or Fishkill, NY

Job DescriptionDescription: About Us: Hanover Bank- When you love your work and the people you work with, careers are made! Embracing diversity, valuing inclusion and showing respect are the foundation upon which we build our team. At Hanover Bank, inclusion means respecting personal beliefs and appreciating that we all have perspectives that matter. We are stronger together as we move toward a shared vision of personal and corporate growth. Whether you are just starting out or a seasoned professional, working for Hanover Bank can launch you on a path to success. With a passion for excellence, we strive to deliver exceptional service to our clients, foster a positive impact in the communities in which we work and live and help our team members achieve their professional goals. When you work with us you are empowered, engaged and encouraged to collaborate because every voice matters, every person counts! Job Summary Hanover Bank is looking for a full-time Commercial Relationship Liaison to join our team. The Commercial Relationship Liaison acts as the primary point of contact for new loan applications. They help Business Development Officers and customers to collect the necessary documentation to initiate an application. After documentation is received, they initiate the application process and prepare the application and supporting documentation for underwriting, including ordering third-party reports. As part of this role, they assist with the administration of Commercial Loan products and Banking services, and with the resolution of operational problems. This position serves as the first line of defense, adhering to the necessary controls, to mitigate unnecessary exposure to risk. Essential Job Duties and Responsibilities Proactively supports customers, Business Development Officers, and the Commercial Lending Administration Department. Proactively embraces all new loan originations from Business Development Officers and collaborates with clients in collecting all related application documentation and ordering third-party reports to ensure timely loan closing. Supports revisions to Abrigo workflows to ensure efficient loan originations and opening of deposit accounts. Aids with the creation and amendment of Procedures that focus on streamlining the customer experience while maintaining regulatory compliance. Undertakes additional roles and responsibilities to support the Commercial Lending Administration Department as reasonably requested by the Director of Commercial Credit. Education and Experience Minimum of 2 years of experience in Banking Operations, Retail, or Credit Experience in Lending Operations, Credit, or Lending is preferred Proficiency with computers, including the Microsoft Suite of products Experience with Sageworks preferred Knowledge of credit products and processes Knowledge of unit/department policies and procedures Skills and Abilities Excellent attention to detail. Excellent verbal and written communication skills Self-motivated, well-organized individual Team player with the ability to adapt to changes, multitask, and work in a fast-paced, growing environment Strong interpersonal skills are necessary for business partner relationships within and outside the organization Our Benefits: Health & Wellness Benefits · Medical, Dental, and Vision insurance (with HSA, FSA, and Commuter Benefits options) · Company-paid Life Insurance and Accidental Death & Dismemberment (AD&D) · Company-paid Long-Term Disability Insurance Voluntary Benefits · Additional Life and AD&D Insurance for employee, spouse, and dependents · Voluntary Short-Term Disability Insurance · Pet Insurance · Legal Services Plan · Accident Insurance · Hospital Indemnity Insurance · Cancer Care Insurance Retirement · 401(k) Plan with Company Match Time Off & Recognition · Paid Personal Time Off (PTO) · Paid Company Holidays · Annual Performance Bonuses · Annual Salary Increases Employee Engagement · Company-sponsored Events · Employee Contests and Recognition Programs Salary: $75,000.00 - $90,000.00 ; placement within this range will vary based on experience and skill level. Hanover Bank is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Requirements:

Apply Description About Us: Hanover Bank- When you love your work and the people you work with, careers are made! Embracing diversity, valuing inclusion and showing respect are the foundation upon which we build our team. At Hanover Bank, inclusion means respecting personal beliefs and appreciating that we all have perspectives that matter. We are stronger together as we move toward a shared vision of personal and corporate growth. Whether you are just starting out or a seasoned professional, working for Hanover Bank can launch you on a path to success. With a passion for excellence, we strive to deliver exceptional service to our clients, foster a positive impact in the communities in which we work and live and help our team members achieve their professional goals. When you work with us you are empowered, engaged and encouraged to collaborate because every voice matters, every person counts! Job Summary: Hanover Bank is looking for a full-time Portfolio Manager I to join our team. The Portfolio Manager I is responsible for maintaining and monitoring an existing commercial loan portfolio and working closely with the Director of Commercial Credit. The Portfolio Manager is expected to maintain close contact with their clients to identify opportunities to expand the business relationship, both in loans and the Bank's other products and services. They are also responsible for identifying and addressing potential credit risk. Job Duties and Responsibilities: Manage all aspects of the borrower relationship in assigned loan portfolio, including: Monitoring compliance with loan covenants. Assisting with loan reviews based on current financial information. Proactively completing loan renewals and modifications. Monitor maturities in the portfolio and ensure they are addressed appropriately. Communicating with and visiting customers and updating the credit file with associated call reports. Addressing customer inquiries or requests for additional financing and/or other bank products. Processing loan advances. Monitoring interest reserves and replenishment. Monitoring borrowing base compliance. Assisting with the processing of paydowns and payoffs. Ensuring the timely payment collection and monitoring delinquencies. Aid in the development of portfolio management processes and procedures. Education and Experience 3+ experience in loan underwriting/commercial borrower relationship management/loan portfolio management and/or portfolio analytics. Bachelor's degree in Finance/Accounting/Business Administration or related field preferred but not required. Formal Credit training or commensurate training or experience. Skills and Abilities Excellent verbal and written communication skills. Team player with the ability to adapt to changes, multi-task, and work in a fast-paced growing environment. Knowledge of financial statement spreading and credit analysis Technical skills including the use of the Microsoft Office Suite. Knowledge of Sageworks also preferred. Strong negotiation skills. Our Benefits: Health & Wellness Benefits · Medical, Dental, and Vision insurance (with HSA, FSA, and Commuter Benefits options) · Company-paid Life Insurance and Accidental Death & Dismemberment (AD&D) · Company-paid Long-Term Disability Insurance Voluntary Benefits · Additional Life and AD&D Insurance for employee, spouse, and dependents · Voluntary Short-Term Disability Insurance · Pet Insurance · Legal Services Plan · Accident Insurance · Hospital Indemnity Insurance · Cancer Care Insurance Retirement · 401(k) Plan with Company Match Time Off & Recognition · Paid Personal Time Off (PTO) · Paid Company Holidays · Annual Performance Bonuses · Annual Salary Increases Employee Engagement · Company-sponsored Events · Employee Contests and Recognition Programs Salary: $75,000 - $90,000 ; placement within this range will vary based on experience and skill level. Hanover Bank is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources and assists with navigating resources available and provide assistance with addressing SDoH barriers and care gaps. This position educates and assists with the enrollment and recertification process for Marketplace Facilitated Enrollment (MFE): On and Off Marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market - Qualified Health Plan (QHP). This position requires working occasional evenings and weekends for outreach and community events. *Must be able to drive independently within the Health Plan regions Essential Accountabilities: Level I • Educates Medicaid, Medicare, and Commercial members on healthcare benefits, and community resources through home visits and outreach. • Educates and assists members with accessing care, Case Management program and benefits and government cell phone programs. • Coordinates, plans and attends community events, including school events, health fairs and various community initiatives. Proactively informs and increases awareness of heath care offerings, state regulations and the Excellus/Univera brand/products at said events and within assigned territories. • Completes scheduled and unscheduled home visits for noncompliance, gaps in care, community resource needs, and other high-risk issues. • Conducts targeted phone calls for compliance, HEDIS initiatives and health risk assessments. • Collaborate with Case Management on the status of high-risk member referrals. • Assists in finding and connecting members to community social services and agencies. Enroll or refer qualified members in a health home. • Communicates health insurance program options, fundamentals of all the health insurance products, benefits, and associated costs based on analysis of the applicant's situation in Marketplace. • Assists individuals and families with securing and providing required documentation to demonstrate age, residency, and income as is required by the Marketplace. • Interprets a variety of complex instructions from the MFE Training Manual to assist applicants. Provides critical assessment and analysis which effects insurance enrollment for families and children. Presents all aspects of eligibility, enrollment and available products to community audiences. • Meets with applicants in locations that have additional MFE resource backup. • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs. • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. • Regular and reliable attendance is expected and required. • Performs other functions as assigned by management. Level II (in addition to Level I Essential Accountabilities) • Manage the incoming Community Connections Referrals. • Maintain the Community Resource Guide as needed. • Ensure educational materials and supplies are replenished and available for use. • Maintain the in-house Food Pantry ensuring all non-perishable items are within use by date. • Works with management to participate in training process for new hires and team refreshers. Supervise Intern and/or mentor new hires to team; providing first level problem resolution, share Lifetime way cultural expectations, ensure successful on-boarding and engagement in role. • Works with management on establishing influential relationships in the community within assigned territory. • Attends community IPA/Navigator Agency as instructed. • Represents the company in small/large community-based organization meetings as required/complement or collaboration with Community Engagement Program Manager. • Gain Subject Matter Expertise (SME) level in key focus area; develop training curriculum and facilitate workshop for team in conjunction with management team. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • High school diploma or GED required. Associate degree preferred. • Minimum of two years of social services, community outreach, or education experience required. • Marketplace Facilitated Enroller certification preferred. • Demonstrated problem solving, interpersonal and communication skills. • Prior experience and working knowledge in Microsoft Suite including Excel and Word. Level II (in addition to Level I Minimum Qualifications) • Minimum of two years' experience working in the Community Connections Representative role. • Marketplace Facilitated Enroller certification required. Maintenance of certification through continuing education/training essential. • Demonstrated attention to detail. • Demonstrated leadership skills. • Demonstrated knowledge and experience of health care industry and Health Plan business. • Demonstrated ability to organize and represent an organization at community events preferred. • Highly effective communicator. Physical Requirements: • Ability to work in a home office for continuous periods of time for business continuity. • Ability to travel across the Health Plan service region for meetings and/or trainings as needed. • Ability to lift, carry, push, or pull 15 pounds or less. • Reaching, crouching, stooping, kneeling required. • Must have a valid Class D license and ability to operate a motor vehicle. • The ability to hear, understand and speak clearly while using a phone, with or without a headset. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade N4: Minimum $19.22 - Maximum $30.76 Level II: Grade N5: Minimum $20.02 - Maximum $33.03 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

At MVP Health Care, we're on a mission to create a healthier future for everyone which requires innovative thinking and continuous improvement. To achieve this, we're looking for an Overpayment Recovery and Monitoring Analyst to join #TeamMVP. If you have a passion for managing audits, medical coding, and analytical thinking and this is the opportunity for you. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work** for and one of the **Best Companies to Work For in New York** **Qualifications you'll bring:** + Bachelor's degree in Health Administration, Business, Economics, Health Informatics, or related field. Associate's degree with the equivalent combination of related experience may also be considered. + Coding certification, such as AAPC CPC, CIC, COC, CCS is required. + The availability to work full-time, virtual in New York State + A minimum of three (3) years' experience in a professional coding environment and three (3) years' experience in auditing and/or reviewing in relevant healthcare industry experience. + Intermediate knowledge of provider reimbursement methodologies and all current coding methodologies. + Intermediate knowledge of Health Insurance and various plan types. Intermediate analytical, problem-solving skills and attention to details. + Ability to initiate education with providers and make internal recommendations for process improvements. Goals and outcomes of the recommendations and education must be measurable. + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction **Your key responsibilities:** + Manage recurring audit inventories, ensuring timely progression and completion of existing audits. + Identify and initiate new audits as patterns emerge through risk-based monitoring efforts, datamining, and other routine payment policy reviews. + Analyze new opportunities to substantiate, size, and prioritize audit needs, and develop audit protocols for new audit types. + Report suspected fraud and abuse to the SIU for further investigation and identify providers in need of education. + Collect and validate Key Performance Indicators (KPI's) from payment integrity functions across the organization. + Assist in the reporting of monthly metrics and participate in cross-functional audit operations. + Handle department projects, participate in committees relevant to payment integrity, and support process improvement efforts. + Participate in training and development activities within the department and corporation. + Perform other audit activities and manual reviews as requested, ensuring accuracy of claims and supporting overall payment accuracy. + Perform research using "best practices" in auditing methodologies, remaining current in CPC coding, reimbursement methodologies, MVP Policies and Procedures, and updates in professional literature. + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** Virtual within New York State \#cs **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** . **Job Details** **Job Family** **Legal** **Pay Type** **Salary** **Hiring Min Rate** **56,200 USD** **Hiring Max Rate** **82,000 USD**

Qualifications you'll bring: Two or more years in a customer service or sales environment, with some experience in the health care industry such as a hospital, medical office, or health insurance company. The ability to speak more than one language preferred (for example, English and Bengali, Hindi an/or Spanish). An Associate degree or equivalent combination of education and related experience. The availability to work full-time, virtual with daily local travel (some evening and weekend hours required). Must have a valid driver's license. Curiosity to foster innovation and pave the way for growth. Humility to play as a team. Commitment to being the difference for our customers in every interaction. Your key responsibilities: Spearhead our membership growth initiatives in crucial target areas by identifying eligible individuals and seamlessly enrolling them in a variety of plans including Medicaid, Child Health Plus, Essential Plan, Qualified Health Plans (QHPs), HARP, Off-Exchange, Medicare Advantage (MA) products, and Dual Eligible Special Needs Plans (D-SNP). Conduct both individual and group outreach activities to present our innovative health care solutions on- and off-site at various events-from health fairs and community expos to festivals and holiday-themed gatherings-ensuring MVP's presence is both seen and felt. Your collaborative efforts alongside our Field Marketing and Community Engagement Representatives will be pivotal in driving growth and visibility in assigned territories. Foster positive relationships with community-based organizations, medical provider partners, and community contacts to develop a robust network within your territory. Generate, track, and convert qualified leads and referrals into MVP customers. Lead two monthly events that highlight our progressive health solutions directly to the communities we serve, strengthening ties and enhancing our brand's impact. Navigate the local landscape with required travel, embracing the opportunity to bring MVP's customer-centric philosophy to life across our footprint. Participate in necessary screenings and provide proof of immunization as part of our commitment to community well-being. Demonstrate the dynamic capability to transport up to 30 lbs. of promotional materials, which play a key role in educating and empowering our customers about their health care choices. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing health care delivery and being the difference for the customer. Where you'll be: Remote with local travel (this role is salary plus incentive and travel reimbursement) #CS

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a **Bilingual Health Care Enrollment Representative** to join #TeamMVP. This is the opportunity for you if you have a passion for health equity, a knack for strategic engagement and a love for your community. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work For in the NY Capital District** , one of **the Best Companies to Work For in New York** , and an **Inclusive Workplace** . **Qualifications you'll bring:** + Two or more years in a customer service or sales environment, with some experience in the health care industry such as a hospital, medical office, or health insurance company. + The ability to speak more than one language (for example, English and Spanish). + An Associate's degree or equivalent combination of education and related experience. + The availability to work full-time, hybrid, including local travel weekdays, nights and weekend for events. + Must have a valid driver's license. + Curiosity to foster innovation and pave the way for growth. + Humility to play as a team. + Commitment to being the difference for our customers in every interaction. **Your key responsibilities:** + **Spearhead our membership growth initiatives in crucial target areas** by identifying eligible individuals and seamlessly enrolling them in a variety of plans including Medicaid, Child Health Plus, Essential Plan, Qualified Health Plans (QHPs), HARP, Off-Exchange, Medicare Advantage (MA) products, and Dual Eligible Special Needs Plans (D-SNP). + **Conduct both individual and group outreach activities** to present our innovative health care solutions on- and off-site at various events-from health fairs and community expos to festivals and holiday-themed gatherings-ensuring MVP's presence is both seen and felt. Your collaborative efforts alongside our Field Marketing and Community Engagement Representatives will be pivotal in driving growth and visibility in assigned territories. + **Foster positive relationships** with community-based organizations, medical provider partners, and community contacts to develop a robust network within your territory. + **Navigate the local landscape with required travel** , embracing the opportunity to bring MVP's customer-centric philosophy to life across our footprint. + **Participate in necessary screenings and provide proof of immunization** as part of our commitment to community well-being. + **Demonstrate the dynamic capability** to transport up to 30 lbs. of promotional materials, which play a key role in educating and empowering our customers about their health care choices. + **Contribute to our humble pursuit of excellence by performing various responsibilities** that may arise, reflecting our collective goal of enhancing health care delivery and being the difference for the customer. **Where you'll be:** + Hybrid with local travel in Dutchess or Orange Counties. This opportunity is salary, plus quarterly incentives and travel reimbursement. \#CS **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** . **Job Details** **Job Family** **Outreach** **Pay Type** **Salary** **Travel Required** **Yes** **Travel Percentage** **75** **Hiring Min Rate** **64,000 USD** **Hiring Max Rate** **70,000 USD**

The Software Engineer is responsible for working on projects that are currently being visualized or developed by our organization. This role will be involved with the Software Development Life Cycle methodology and framework, directing software system validation and testing methods, as well as directing software programming initiatives. This position works closely with clients and cross-functional departments to communicate project statuses and proposals. Essential Accountabilities: Level I • Develops code, analyzes, researches, and resolves associated system issues. • Participates in on-call production support rotation. • Supports, maintains, creates and follows all documented IT processes and standards, application documentation and design and code reviews. • Collaborates and communicates with team members and associates throughout the business to understand requirements and identify application impacts. • Creates individual work plans, specifications and programs with guidance utilizing development procedures and standards. • Develops skillset in one tool and ability to utilize the approved source control. • Establishes a basic understanding of the Software Development Life Cycle methodology and framework use by your team, post one year demonstration of basic understanding and application of this skill. • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. • Regular and reliable attendance is expected and required. • Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) • Participates in strategic discussion and decision-making. • Serves as a mentor in their area(s) of technical expertise. • Provides input to creation and documentation of organizational standards. • Continuous development including the skillset of a second programming language and one tool/platform. • Develops and implements an intermediate understanding of the Software Development Life Cycle methodology and framework. • Develops understanding in one supported enterprise technology, post one year demonstration of intermediate understanding and application. Level III (in addition to Level II Accountabilities) • Proactively identifies process and technical deficiencies, troubleshooting and offering solutions to resolve. • Identifies best practices and participates in creation of organizational standards. • Progresses the Software Development Life Cycle methodology and framework forward by demonstrating advanced understanding and application. • Provides intermediary understanding of one supported enterprise technology and developing an additional basic understanding of another enterprise technology. Post one year demonstration of intermediate understanding, and application of an additional technology. Level IV (in addition to Level III Accountabilities) • Assists with software and system design and architecture within the assigned portfolio. • Develops strategies to mitigate risk and translates those strategies into specific action plans. • Acts as a subject matter expert in their area(s) of technical expertise. Identifies best practices and drives creation of Organizational Standards and processes. • Progresses the Software Development Life Cycle methodology and framework forward by demonstrating advanced understanding and application. • Provides understanding and expertise of two (2) supported enterprise technologies and developing an additional basic understanding of another enterprise technology. Post one year demonstration of advanced understanding, and application of, additional technologies. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • Associate's degree in computer science, information technology or related field. In lieu of a degree, three (3) years of experience required. Bachelor's degree preferred. • Basic knowledge of at least one (1) programming language, such as C#/. NET, Java, SQL, C++, Python, Visual Basic or JavaScript. • Basic understanding of one (1) of the following tools/platforms such as: Informatica, CI/CD, Pega, Power BI, Cognos. • Basic knowledge of at least one (1) operating system, such as Unix-Based or Windows. • Basic database experience • Basic understanding of software testing and quality. • Demonstrated basic ability to effectively communicate and partner with team members and direct leadership to understand user stories and identify application and system impacts. • Demonstrated advanced problem-solving skills. • Demonstrated basic ability to implement security architecture principles, and best practice standards that align to the Organization's overall business and strategy. • Basic technical knowledge of techniques, standards, and state-of-the-art capabilities for authentication and authorization, applied cryptography, data masking, encryption, security vulnerabilities, and remediation. • Basic understanding of OpenAPI Specification (OAS) and Open Web Application Security Project (OWASP) vulnerabilities and risks. Level II (in addition to Level I Qualifications) • Intermediate knowledge of at least one (1) programming language, such as C#/.NET, Java, SQL, C++, Python, Visual Basic or JavaScript. • Intermediate Experience with one (1) of the following tools/ platforms such as, Informatica, CI/CD, Pega, Power BI, Cognos. • Intermediate knowledge of at least one (1) operating system, such as Unix-Based or Windows. • Intermediate database experience • Intermediate understanding of software testing and quality. • Intermediate knowledge and familiarity with the Software Development Life Cycle development methodologies. • Intermediate knowledge of source control processes and application. • Intermediate technical knowledge of techniques, standards, and state-of-the-art capabilities for authentication and authorization, applied cryptography, data masking, encryption, security vulnerabilities, and remediation. • Intermediate understanding of OpenAPI Specification (OAS) and Open Web Application Security Project (OWASP) vulnerabilities and risks. Level III (in addition to Level II Qualifications) • Advanced knowledge of at least one (1) programming language, such as C#/.NET, Java, SQL, C++, Python, Visual Basic or JavaScript. • Advanced knowledge and experience with one (1) of the following tools/platforms, such as Informatica, CI/CD, Pega, Power BI, Cognos. • Advanced knowledge of at least one (1) operating system, such as Unix-Based or Windows. • Advanced database experience • Advanced understanding of software testing and quality. • Advanced experience with the Software Development Life Cycle methodology and framework. • Advanced knowledge of source control processes and application. • Advanced technical knowledge of techniques, standards, and state-of-the-art capabilities for authentication and authorization, applied cryptography, data masking, encryption, security vulnerabilities, and remediation. • Advanced understanding of OpenAPI Specification (OAS) and Open Web Application Security Project (OWASP) vulnerabilities and risks. Level IV (in addition to Level III Qualifications) • Expert experience with one (1) of the following tools/ platforms such as Informatica, CI/CD, Pega, Power BI, Cognos or the above programming languages. • Expert knowledge of at least one (1) operating system, such as Unix-Based or Windows. • Expert database experience and understanding of software quality. • Expert technical knowledge of techniques, standards, and state-of-the-art capabilities for authentication and authorization, applied cryptography, data masking, encryption, security vulnerabilities, and remediation. • Expert understanding of OpenAPI Specification (OAS) and Open Web Application Security Project (OWASP) vulnerabilities and risks. Physical Requirements: • Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer. • Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. • Ability to travel across the Health Plan service region for meetings and/or trainings as needed. • Ability to work in a home office for continuous periods of time for business continuity. *********** In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): E8 - Min 98,297 Mid 137,616 Max 176,935 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Qualifications you'll bring: Bachelor's degree in Health Administration, Business, Economics, Health Informatics, or related field. Associate's degree with the equivalent combination of related experience may also be considered. Coding certification, such as AAPC CPC, CIC, COC, CCS is required. The availability to work full-time, virtual in New York State A minimum of three (3) years' experience in a professional coding environment and three (3) years' experience in auditing and/or reviewing in relevant healthcare industry experience. Intermediate knowledge of provider reimbursement methodologies and all current coding methodologies. Intermediate knowledge of Health Insurance and various plan types. Intermediate analytical, problem-solving skills and attention to details. Ability to initiate education with providers and make internal recommendations for process improvements. Goals and outcomes of the recommendations and education must be measurable. Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Manage recurring audit inventories, ensuring timely progression and completion of existing audits. Identify and initiate new audits as patterns emerge through risk-based monitoring efforts, datamining, and other routine payment policy reviews. Analyze new opportunities to substantiate, size, and prioritize audit needs, and develop audit protocols for new audit types. Report suspected fraud and abuse to the SIU for further investigation and identify providers in need of education. Collect and validate Key Performance Indicators (KPI's) from payment integrity functions across the organization. Assist in the reporting of monthly metrics and participate in cross-functional audit operations. Handle department projects, participate in committees relevant to payment integrity, and support process improvement efforts. Participate in training and development activities within the department and corporation. Perform other audit activities and manual reviews as requested, ensuring accuracy of claims and supporting overall payment accuracy. Perform research using "best practices" in auditing methodologies, remaining current in CPC coding, reimbursement methodologies, MVP Policies and Procedures, and updates in professional literature. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Virtual within New York State #cs