Empower. Unite. Care. MetroPlusHealth. is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health Hospitals. MetroPlus. Health. provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Sta...
MetroPlusHealth. is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Sales Representative II is responsible for educating and assisting qualified individuals with purchasing affordable health insurance coverage and/or obtaining an eligibilit...
MetroPlusHealth. is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Sales Representative II is responsible for educating and assisting qualified individuals with purchasing affordable health insurance coverage and/or obtaining an eligibilit...
Job Description – SIU Clinical Certified Coder / RN Chart Reviewer. Job Title: SIU Clinical Certified Coder. Department: Clinical Services Admin. Schedule: Hybrid, Mon–Fri, 9 AM–5 PM (35 hrs/week). Location: New York, NY. Overview. MetroPlusHealth seeks an experienced RN Clinical Coder to support the Special Investigations Unit (SIU) in detecting, preventing, and investigating healthcare Fraud, Waste, and Abuse (FWA). The role involves clinical c...
MetroPlus. Health. is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. Under the direction of the Sales Regional Manager, the Sales Supervisor will be primarily responsible for the oversight and monitoring of the daily sales activities of all En...
Position Overview. 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 diagnoses, medical necessity of procedures, appropriate s...
Position Overview. The BH Claims Supervisor will oversee personnel involved in the adjudication of behavioral health-related medical claims. This position will provide support to the ASP Manager and other MetroPlusHealth employees regarding the adjudication of complex, difficult, and non-routine claims for multiple lines of business. The incumbent will coordinate with the ASP Manager to ensure the BH Claims team is able to meet expectations for t...
Position Overview. The Customer Success Specialist I is responsible for supportingMetroPlusHealth members and other key stakeholders across the customer’s journey. They are expert on the system and understand the NYSOH processes to quickly route members to the appropriate resolution and support. The Customer Success Specialist I works as a liaison to ensure proper processes are introduced and implemented such that the MetroPlusHealth experience i...
Position Overview. The BH Claims Supervisor will oversee personnel involved in the adjudication of behavioral health-related medical claims. This position will provide support to the ASP Manager and other MetroPlusHealth employees regarding the adjudication of complex, difficult, and non-routine claims for multiple lines of business. The incumbent will coordinate with the ASP Manager to ensure the BH Claims team is able to meet expectations for t...
Position Overview. The Customer Success Specialist I is responsible for supportingMetroPlusHealth members and other key stakeholders across the customer’s journey. They are expert on the system and understand the NYSOH processes to quickly route members to the appropriate resolution and support. The Customer Success Specialist I works as a liaison to ensure proper processes are introduced and implemented such that the MetroPlusHealth experience i...
Position Overview. The Salesforce Analyst is accountable for performing analysis and administrative support specifically to Salesforce (SF) for the Claims Department. Incumbent will triage new cases and route/reroute cases as needed, assign salesforce cases to staff, will monitor, analyze, track and trend salesforce cases, will assist with compilation of key salesforce case metrics and will perform routine administrative case functions within the...
Position Overview. MetroPlus. Health. is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Data Integrity Project Analyst is responsible for supporting the Provider Network Data System (PNDS) process, assisting in the development of individua...
