Medicare Claims Processing Leader, Medicare Claims
Company: MVP Health Care
Location: Albany
Posted on: October 13, 2021
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Job Description:
Medicare Claims Processing Leader, Medicare Claims
Headquarters Office, 625 State Street, Schenectady, New York,
United States of America
Tuesday, October 5, 2021
Over 35 years strong and fueled by 1,700 smart, passionate
employees across New York state and Vermont, MVP is full of
opportunities to grow. We are a nationally recognized,
award-winning leader for a reason. The beating heart of our company
is a wide range of employees from a diverse set of backgrounds-tech
people, numbers people, even people people-working together to make
health insurance better. If you are ready to join a thriving,
mission-driven company where you can create your own opportunities
and make a positive difference-it's time to make a healthy career
move to MVP!
Status: Full-time, Exempt
Provide technical and administrative oversight to a team of
cross-functional Medicare, DSNP and UVMNH claim examiners for
adjudication of claims and adjustments. Responsibilities will
include ensuring that all activity is consistent with company
policies and procedures. The role will also provide oversight and
direction in the duties of monitoring attendance, personnel issues,
and performance evaluations, interviewing and completing the
disciplinary action process, as needed. Will also support and
mentor to successfully build highly skilled team members. Achieves
operational objectives by contributing information and
recommendations to strategic plans and reviews; preparing and
completing action plans; implementing automation, production, and
quality standards; resolving problems; identifying trends;
determining system improvements; implementing change. Effectively
handle, root cause, and resolve internal and external customer
complaints. Provide guidance and direction to team members and
external departments.
Responsible for staff scheduling, including PTO time, back-up for
employees and cross-training for extended absences.This role will
be responsible for representing department during audits by
federal, state and client entities. Responsible for understanding
the Medicare and DSNP model contracts, and all applicable federal
and state regulations and mandates related to Medicare Advantage
and Essential Plan services and products.Works with other
departments to establish and maintain collaborative relationships
toward achieving company goals. Act as back up to Leader of Gov't
Programs and Integrated Health. Attend meetings as needed. Handle
escalated issues effectively or escalates to their Leader items
outside their immediate control. Ability to maintain
confidentiality and adhere to regulatory compliance issues as they
exist and change from time to time. Performs other related duties
as assigned.
POSITION QUALIFICATIONS
Minimum Education:
4 year college degree, preferrable in Business Administration or
Business Management, or three or more years of related work
experience.
Minimum Experience:
Minimum three years claim processing required. One year of
supervisory experience in claims or call center preferred.
Required Skills:
About MVP
MVP Health Care is a nationally recognized, not-for-profit health
insurer caring for more than 700,000 members in New York and
Vermont. Committed to the complete well-being of our members and
the communities we serve, MVP makes health insurance more
convenient, more supportive, and more personal. We are powered by
the ideas and energy of more than 1,700 diverse, employees from all
backgrounds, committed to having a positive impact on the health
and wellness of everyone we serve. MVP Health Care is an
Affirmative Action/ Equal Employment Opportunity (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),
and the EEO is the Law Poster and Supplement 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 hr@mvphealthcare.com
Please apply and learn more - including how you may become a proud
member of our team.
Other details
Apply Now
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Full-time, Exempt\nProvide technical and administrative\noversight
to a team of cross-functional Medicare, DSNP and UVMNH
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attendance, personnel issues, and performance
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build highly skilled team members.\nAchieves operational objectives
by contributing information and recommendations\nto strategic plans
and reviews; preparing and completing action plans;\nimplementing
automation, production, and quality standards; resolving
problems;\nidentifying trends; determining system improvements;
implementing change.\nEffectively handle, root cause, and resolve
internal and external customer\ncomplaints. Provide guidance and
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responsible for representing\ndepartment during audits by federal,
state and client entities.\nResponsible for understanding the
Medicare and DSNP model contracts, and all\napplicable federal and
state regulations and mandates related to Medicare Advantage\nand
Essential Plan services and products.Works with other\ndepartments
to establish and maintain collaborative relationships
toward\nachieving company goals. Act as back up to Leader of Gov't
Programs and\nIntegrated Health. Attend meetings as needed. Handle
escalated issues\neffectively or escalates to their Leader items
outside their immediate control.\nAbility to maintain
confidentiality and adhere to regulatory compliance issues\nas they
exist and change from time to time. Performs other related duties
as\nassigned.POSITION QUALIFICATIONSMinimum Education:4 year
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Keywords: MVP Health Care, Albany , Medicare Claims Processing Leader, Medicare Claims, Other , Albany, New York
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