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  • Tarrytown Office
    Req #295
    Monday, September 16, 2019
    Status: Full-time, Non-Exempt          Summary: Responsible for processing all aspects of Medicaid, Child Health Plus and HARP enrollment into core systems with a strong attention to detail. Process enrollments, changes and terminations from rosters, email correspondence and electronic data sources. Process error reporting and system reconciliation files. Respond to eligibility inquiries for both internal and external customers. Serve as a team ... More
  • Rochester Office
    Req #281
    Monday, September 16, 2019
    Summary:Under the directionof the Supervisor, Revenue Data Management – Plan Payment and PDEResponsible for performing the daily operations of Medicare and ACA exchange payment processes including but not exclusive to; report development andpayment reconciliations, completion of compliance driven processes toconsistent and accurate revenue streams. Must constantly monitor the status of new,existing, and previous discrepancies or recovery situations.  Actively participates in the development,test ... More
  • Rochester Office; Tarrytown Office
    Req #244
    Monday, September 16, 2019
    Summary:Under the direction of the Leader, Revenue Data Management – NYS Encounter, OperationsPerform daily operations for NYS. Encounter operations including but not exclusive to; file submissionsand reconciliation, data integrity reviews, IT request ticket management, develop and perform applicationtesting functions, reporting, and supporting business partner functions for Revenue Data Management.  Actively participates in the development testing and implementation of technical solutions to me ... More
  • Rochester Office
    Req #290
    Friday, September 13, 2019
    Status: Full-time, Exempt: No Summary: Thoroughly investigates and resolves member appeals and CTM’s in a professional and timely manner following departmental and company processes and within time limits set forth by CMS guidelines. Monitors appeals for trends and potential service improvement opportunities.  Duties include:  Investigates each appeal by gathering pertinent information from members, providers, facilities and internal resources in order to respond to each ... More
  • Headquarters Office; Rochester Office
    Req #289
    Friday, September 13, 2019
    Status: Full-time, Exempt: Yes  Provides data analysis and projected utilization and costs for all lines of business and sub-groupings in aggregate for appropriate action. Performs monthly analysis of actual utilization and cost trends and compares/adjusts projected rates. Performs quarterly data pulls for rebate submissions and reconciliations. Evaluates and identifies inappropriate prescribing patterns from prescription and medical claims data for potential action by appropriate personnel. Co ... More
  • Headquarters Office
    Req #291
    Friday, September 13, 2019
     Status: Full-time, Non-Exempt       Summary: Primarily responsible for the entry, management, verification and reporting of the MVP participating and non-participating provider data, with the objective of keeping all information relating to these providers accurate and up to date enabling accurate and timely payment of claims, accurate marketing and reporting, and effective recruitment of physicians. This includes daily data entry or updating of information in Cactus and/or Facets ... More
  • Headquarters Office; Rochester Office
    Req #286
    Tuesday, September 10, 2019
    Status: Full-time, Exempt: No This position will be responsible for providing administrative/ clerical services and overall project coordination to ensure effective, efficient program operations under the direction of the Leader, HEDIS Operations. This individual will be responsible for monitoring the team’s annual workplan and managing related tasks. The specialist will support HEDIS Operations team members, and will be responsible for: • Scheduling meetings and keeping meeting minutes• Manag ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #275
    Tuesday, September 10, 2019
    Status: Full-time, Exempt: Yes Reviews and evaluates provider requests for authorization of services: prior to initiation of care, for continuation/ extension of care or after care has been rendered. Determinations of medical necessity and appropriateness of care are based on predetermined criteria and/or guidelines. Ensures that MVP benefits and policies are properly interpreted, and that care is rendered in the most appropriate site of service with a focus on quality care and cost-efficie ... More
  • Tarrytown Office
    Req #259
    Monday, September 9, 2019
    Status: Full-time, Exempt: No          Summary: This position acts as the coordinator and team support for all aspects of the Westchester Cares Action Program a Care Management Agency for NYS Health Home. This position also strongly supports the case management process by assisting with all care coordination services and member outreach under the direction of a Licensed Healthcare Case Manager. This position requires 50% field work with Medicaid managed care members and interact ... More
  • Rochester Office
    Req #284
    Monday, September 9, 2019
    Professional, Facility Relations Status: Full-time, Exempt: YesThis position supports the Network Management Strategy in maintaining positive, cooperative relationships with facilities’ and IPA’s billing administrators and support personnel.  Orients facility and IPA staff on MVP Health Care policies and procedures.  Identifies, tracks and trends issues identified by employees, facility staff, and assists with resolution.  Assists the Communications Department in developing and communicating in ... More
  • Headquarters Office
    Req #282
    Friday, September 6, 2019
    Band Level: Professional II    Status: Full-time, Exempt Referral Bonus: Standard Talent Acquisition Representative: Jan Cozzy, jcozzy@mvphealthcare.comThis role will work closely with all departments implementing and ensuring the core system works effectively across teams while maximizing efficiency and capitalizing on the full features and benefits of the platform. Participate in planning, organizing and management of all core system projects to ensure effective operations. Monitor cor ... More
  • Rochester Office
    Req #283
    Thursday, September 5, 2019
    Nonexempt / Part time JOB SUMMARY:Under the direction of the Executive Assistant, IT&TS / CIO:Performs administrative duties for IT leadership team as well as provides general administrative support to the entire IT&TS department across three offices (onsite support of Rochester staff, remote support of Schenectady and Tarrytown staff as needed).  Schedule management for department leaders, scheduling and coordination of onsite and offsite meetings. Screen vendor inquiries as an aide to departme ... More
  • Headquarters Office
    Req #273
    Thursday, September 5, 2019
    MVP Healthcare seeks an experienced, energetic, engaging and visionary leader who wants to become part of an exciting, vibrant community of information technology professionals supporting MVP Healthcare’s mission: ensure that our members will have access to quality health care and that their health care needs will be met.   Information technology plays a vital and ever-expanding role in the mission. MVP's information technology environment is highly distributed and diverse, with strong leader ... More
  • Headquarters Office; Rochester Office
    Req #280
    Wednesday, September 4, 2019
    Full-time, Non-ExemptSummary:Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. Is responsible for the timely and accurate adjud ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #256
    Wednesday, September 4, 2019
    Status: Full-time, Exempt: Yes This position makes triage and referral decisions requiring clinical judgement.  The individual will follow members for mental health , substance abuse and co-morbid medical disorders according to the benefit guidelines and policies across the continuum of care.  The Behavioral Health Case and Utilization Manager will review all requests for inpatient services in view of the appropriate BH and MVP standards, such as Interqual and OCADTR guidelines, assuring that a ... More
  • Tarrytown Office
    Req #276
    Tuesday, September 3, 2019
    This role will support the main processes of the Employee Relations (ER) function of HR and will actively contribute to the planning, coordination and execution of strategic and operational initiatives. This role will support the following from an Employee Relations perspective: Develops and implements human resource policies, programs, processes and guidelines designed to meet the needs of the company, promote retention and promote positive employee relations and strong corporate culture. Suppo ... More
  • Headquarters Office
    Req #279
    Tuesday, September 3, 2019
    The Professional, Talent Development will support the main processes within the Development Function (in HR) and will actively contribute to the planning and execution of strategic and operational initiatives. Establish, maintain, monitor, and measure effectiveness of corporate-wide learning & development programs. Programs include, but are not limited to: Onboarding, Lead MVP (Leadership Development) and Lead+ (High Potential Employee). Serve as a facilitator within each of these programs. Woul ... More
  • Headquarters Office; Rochester Office
    Req #278
    Tuesday, September 3, 2019
    Professional, Mktg & Comm, Internal & Corp  Summary: This position works as part of an integrated team designed to provide cross-functional communication and marketing expertise to the business with a focus on Internal and Corporate constituents.  Overall team objectives include, but are not limited to: identifying, developing and utilizing the most appropriate communication vehicle(s) to reach the targeted audience; create, plan, and provide communication solutions to strateg ... More
  • Tarrytown Office
    Req #247
    Tuesday, September 3, 2019
    Associate, Care Center Representative Medicaid  Band: Associate IStatus: Full-time, Exempt: No Referral Bonus: Standard Talent Acquisition Representative: Rosemary Troncoso, rtroncoso@mvphealthcare.com   Summary: Provides optimum customer service as required to maintain existing members and prevent cancellations. The Care Center Representative must take full responsibility for every call to ensure callers concerns are met. Provides world class customer care to internal and ... More
  • Tarrytown Office
    Req #274
    Tuesday, September 3, 2019
    Associate, Outreach Representative    Summary: The Outreach Representative conducts individual and group Field Outreach activities throughout their regions; promotes MVP throughout their regions, and conducts public presentations on MVP products. The Outreach Representative must provide fair and impartial information to individual Marketplace customers regarding coverage options available through the NY State of Health Marketplace. They help facilitate enrollment in Qualified Health Plans ... More
  • Tarrytown Office
    Req #270
    Tuesday, September 3, 2019
    Associate, Enrollment & Retention Specialist     Summary: The Enrollment and Retention Call Center Representative must provide fair and impartial information to individual Marketplace customers regarding coverage options available through the Exchanges. They help facilitate renewal and enrollment in Qualified Health Plans (QHPs), insurance affordability programs, Medicaid, the Essential Plan, and Child Health Plus as permitted under federal and state guidance. Majority of contact ... More
  • Headquarters Office; Rochester Office
    Req #265
    Friday, August 30, 2019
    This individual will perform and be cross-trained in selected departmental job functions as assigned. These include, but are not limited to: Working as part of team to coordinate all aspects of P+T Committee, with appropriate notification to physician, member, and vendor; Supporting the QI pharmacy initiatives, as well as disease state management functions of the pharmacy department; Providing drug related and benefit information to member services, provider relations, utilization management an ... More
  • Headquarters Office
    Req #271
    Thursday, August 29, 2019
    Status: Full-time, Exempt     This role works with the CRM staff, Marketing & Communications, Business Areas, and the IT Development team to develop the training program for specific CRM initiatives and applications. This position will design, write, and develop instructor-led and technology delivered courses using content developmental tools and will work with business experts to refine course content based on process and training needs, while meeting MVP brand and communication standards. The ... More
  • Headquarters Office
    Req #272
    Thursday, August 29, 2019
    Status: Full-time, Non-Exempt     Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. Is responsible for the timely and accurate ... More
  • Headquarters Office
    Req #263
    Thursday, August 29, 2019
    Performs review of Durable Medical Equipment, Orthotics, prosthetics and other specialty equipment and related services for medical necessity. Applies established Medicare Guidelines or Benefit Interpretation criteria and standards. Responsible for collecting and interpreting medical information for appropriateness of care. Communicates determinations to all parties involved, verbally and in writing, including scope of authorization. Facilitates deployment of services and conducts retrospective ... More