The Salesforce Architect will lead efforts to adapt and Salesforce, offer support to our business and responsible for a wide variety of critical applications built on Salesforce platform. The Salesforce Architect will also provide oversight and responsibility for the performance and operation of the Salesforce Development team through management, leadership, and mentorshi

Claims Relationship Representative Job Ref 104172 Category Claims Department CLAIMS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $50,000.00 Salary Range $50,000.00 $55,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that He

Vice President of Program Management Job Ref 104144 Category Professional Department MHP PMO Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $200,000.00 Salary Range $200,000.00 $226,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We bel

The Inpatient/Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for physician documentation, clinical evidence that supports the d

The Claims User Acceptance Tester (UAT) will be responsible for validating whether all the business requirements have been fulfilled before releasing the actual product to production. The individual will perform positive and negative testing to identify and ensure any defects found are corrected prior to implementation. The Claims UAT will develop and follow a test plan w

The Claims Supervisor is responsible for the daily oversight of claims processes including but not limited to the inquiry and resolution process, adjudication process, user acceptance testing and quality assurance, training, and reporting. In addition, the position assists the claims manager with claims related queue management (i.e. claims, inquiries, refunds, adjudicati

As a Claims Adjustment Specialist I, this individual will be responsible for analyzing standard to complex post paid healthcare claims that require in depth research to determine accuracy and mitigate payment errors. The Claims Adjustment Specialist I will also be responsible for adjusting medical claims that result in overpayment or underpayment due to claim processing s

Under the direction of the Team Lead and Care Manager, the Health & Wellness Advisor I (HWA I) is a member of a team that provides care management services to our high risk Medicaid members to ensure the promotion of their health and wellness. As an integral team member, the HWA I will work in conjunction with the Care Manager to ensure the member receives Comprehensive o

Senior Director of Behavioral Health Strategy Job Ref 105750 Category Behavioral Health Department BEHAVIORAL HEALTH HARP Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $200,000.00 Salary Range $200,000.00 $216,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting com

Responsible and accountable to the Chief Medical Officer for helping to manage health plan medical quality, utilization, and assuring appropriate health care delivery, the Senior Medical Director serves in a policy, operational and strategic capacity. The Senior Medical Director overall purpose is to work across medical management functions, with a focus on Utilization Ma

Senior Director of Medical Directors Job Ref 102619 Category Utilization Review and Case Management Department UTILIZATION MANAGEMENT Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Salary Range $340,000.00 $350,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities thro

Claims Quality Auditor is responsible for reviewing claims to determine if payments have been made correctly. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon benefit configuration, compliance with provider contract agreements, and Federal, State a