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Director of Provider Contract Configuration

Company: MetroPlusHealth
Location: New York
Posted on: February 1, 2025

Job Description:

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 + HospitalsMetroPlusHealth 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, MetroPlusHealth 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position Overview

The Director of Provider Contract Configuration is responsible for evaluating operation processes and procedures for process improvement of MetroPlusHealth Core Applications. Will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing. Job Description

Oversee development and implementation of short/long term business objectivesDirect and support initiatives to focus on projects with plan wide benefit in accordance with corporate budgetary objectivesEnsure provider contracts are configured timely and accuratelyOversee functions performed by delegated vendor(s) as it relates to benefit configuration, claims processing, provider setup and account payable systemManage activities and communications between key business stakeholders and Core System Vendor for implementation of new systems and optimization of current systemsDevelop and oversee SDLC methodology, including business requirements creation and sign-off, Quality Assurance, User Acceptance Testing, Production and Postproduction activitiesAddress operational matters by working with business units to identify system solution to operational issuesParticipate and advise in new business/operational initiativesProvide guidance on current and future system capabilitiesIdentify areas of operational improvement, promote strategic relationships with business areas, vendor, governmental and partner organizationsWork with provider reimbursement tools, collaborate with Claims Operations, Utilization Management, and Network Management to setup pricing methodologies Facilitate improvement of the payment transaction process by interacting with providers and finance teamManage project implementation of upgrades and new products as it relates to Core SystemsMinimum Qualifications
  • Bachelor's Degree from an accredited college or university. A minimum of 10 years of healthcare systems experience such as process improvement, project management or system configuration.
  • Project Management and Staff Supervision a plus
    Professional Competencies
    • Integrity and Trust
    • Customer Focus
    • Functional/Technical skills
    • Written/Oral Communication#LI-Hybrid

Keywords: MetroPlusHealth, East Orange , Director of Provider Contract Configuration, Executive , New York, New Jersey

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