Be a part of the transformation at MVP Health Care. MVP Health Care is a nationally-recognized, regional not-for-profit health insurer. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,700 employees. We employ talented people with diverse backgrounds and experiencetech people, numbers people, even people peopleto make health insurance more convenient, more supportive, and more personal. If youre ready to join a thriving, mission-driven company where you can create your own opportunitiesits time to make a healthy career move to MVP.
This role will be responsible for ensuring great member and provider experience by accurately and efficiently processing claims adjustments, while concentrating on putting our customers at the center of how Operations operates. Ensures accurate and timely processing of claim adjustments/service forms and ad-hoc projects/retro database items in accordance with medical and ancillary guidelines and benefits. Acts as a liaison with other department and outside vendors to resolve claim issues as they arise while also conducting root cause analysis on those issues with a focus on improving the member and provider experience. Completes daily reports as needed with flexibility to move from one project to another on a daily/weekly basis. Evaluates all business processes to proactively identify efficiency opportunities and partners with team leads to implement production and quality standards, identify trends and recognize process improvements with a focus on continuous improvement. Will work to reduce the number of complaints, appeals and DFS issues along with improvement in the average turnaround time and reduction in the number of hand-offs within the organization. Meets all departmental quality and financial goals. Keeps updated on job manual/process changes. Communicates directly with members and providers as needed. Supports a culture of continuous learning, support, and inclusion. Performs other related duties as assigned.
Minimum Education: High School Diploma required. Associates in Health, Business or related field preferred. Relevant work experience may be substituted.
Minimum Experience: Previous medical claims processing experience required. Knowledge of CPT, HCPCS, ICD-9-CM coding systems and medical terminology preferred.
- Strong Verbal and Written Communications
- Critical Thinking and Problem Solving
- Ability to sit at a computer for an extended period of time.
- Experience with Facets and Macess strongly preferred
- Business Analysis preferred
MVP Health Care is an Affirmative Action/Equal Opportunity Employer (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at [email protected]