MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlus Health network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Product Implementation Specialist will use their benefit and Product knowledge to prepare, monitor, and customize benefit changes or payment reimbursement requirements per regulatory guidance. They ensure a smooth benefit implementation based on the request from start through completion. To ensure this happens, they talk with internal business owners, collect data, customize required configuration forms, define objectives, and maintain corporate tracker. The Product Implementation Specialist will act as the point of contact for the company and initiate these implementation processes as quickly as possible..

• Take lead for all Product lines of business for regulatory implementations from NYS Department of Health, NYS Department of Financial Services, and NY State of Health.
• Project manage these regulatory implementations from end-to-end.
• Analyze complex Product benefit configuration and rate implementation projects and build a range of meaningful recommendations.
• Use data, insights, and product specific knowledge to inform conclusions and support decision making.
• Proactively gather information to understand business owner needs.
• Effectively communicate with all business partners including Core Systems, Medical Management, Regulatory and Compliance ensuring appropriate and timely updates to any potentially impacted departments.
• Review and verify documentation for compliance and operational accuracy.
• Assist with CPT code verification for benefit implementations ensuring proper configuration.
• special projects and other related duties as assigned.

• Bachelor's Degree required
• Minimum 1-3 years of experience in health care, medical coding, Product, Regulatory, or other relevant field
• Medical coding experience preferred
• Project Management skills preferred
• Working knowledge of Product department, implementations, and operational aspects of health care
• Skills in Microsoft Excel, PowerPoint, and Word are required

Professional Competencies

• Integrity and Trust
• Customer Focus
• Excellent verbal, written, mathematical, and interpersonal skills
• Able to work collaboratively and efficiently with multidisciplinary teams
• Highly detail-oriented
• Strong presentation skills

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