Business Process Specialist

Business Process Specialist

Job Ref : TE0003

Category : Professional

Department : Provider Network Operations

Location : 50 Water Street, 7th Floor,

New York,

NY 10004

Job Type : Regular

Employment Type : Full-Time

Salary Range : $68,000.00 - $78,000.00

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.

This position will ensure a successful migration to Health Edge / Health Rules Payer (HRP) core system for Provider Network Operations (PNO). This role will be part of cross functional and multi-departmental work groups, representing PNO, in the deployment of HRP, representing our priorities and workflows.

Duties & Responsibilities

• Support migration to a new core claim system (Health Rules Payer or HRP) for Provider Network Operations team (PNO)
• Attend all needed HRP meetings through a phased roll out by product which includes prep, testing and post go live meetings
• Maintain PNO issue tracker for HPR project for PNO Leadership
• Assist in HRP project issue resolution impacting Providers
• Assist in updating HRP or general PNO process documents, policies and / or desktop procedures for PNO as needed
• Prepare executive summaries and / or communication materials to convey HRP changes or updates
• Represent PNO VP or Director at HRP or other operational meetings as needed
• Work on other critical PNO projects as needed
• Assist in provider data quality assurance between CACTUS, PowerStepp, HRP and Salesforce through migration timeline and beyond as programs sunset.
• Monitor provider complaints related to HRP migration and prioritize for appropriate work groups and / or war rooms.
• Responsible for data collection, data extraction, data analysis, and data reporting activities related to HRP migrations and PNO issues
• Act as liaison between the Credentialing, Provider Maintenance, and Customer Service departments and investigate and respond to inter-departmental project-related inquires related to HRP or general PNO work as needed.
• Performs other support activites and duties as assigned

Minimum Qualifications

Professional Competencies

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