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  • Headquarters Office
    Req #324
    Wednesday, October 9, 2019
    Professional, Physical SecurityBe a part of the transformation at MVP Healthcare. MVP Healthcare is a nationally-recognized, regional not-for-profit health plan. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,600 employees.  We are continually evolving the way MVP uses technology to grow our business, transforming the organization through Cloud Computing, Agile Delivery, and DevOps. MVP Information Services business unit i ... More
  • Headquarters Office
    Req #319
    Wednesday, October 9, 2019
    Status: Full-time, Non-Exempt Summary:Monitors and records the quality of work performed by units within theOperations Department for claims processing and/or member eligibilitytransactions, for all regions in all lines of business that are pulled on adaily basis. Identify trends in specific errors and error rates. Determines andrecommends needs for retraining, or clarification of work procedures. Developsand produces, periodic reports based on audits/projects completed, for the QualityControl L ... More
  • Tarrytown Office
    Req #336
    Wednesday, October 9, 2019
    Associate, Chart Procurement Specialist_B  Status: Associate II, Full-time, Exempt: No Referral Bonus: Standard Talent Acquisition Representative: David Przybylo, dprzybylo.consultant@mvphealthcare.com   Summary: This position works with provider offices to obtain medical records for the purpose of the Risk Adjustment team validating diagnoses that were sent to CMS (Center for Medicare & Medicaid Services). Works to collect medical records under ... More
  • Tarrytown Office
    Req #337
    Wednesday, October 9, 2019
    Associate, Chart Procurement Specialist_B  Status: Associate II, Full-time, Exempt: No Referral Bonus: Standard Talent Acquisition Representative: David Przybylo, dprzybylo.consultant@mvphealthcare.com   Summary: This position works with provider offices to obtain medical records for the purpose of the Risk Adjustment team validating diagnoses that were sent to CMS (Center for Medicare & Medicaid Services). Works to collect medical records under ... More
  • Headquarters Office
    Req #331
    Tuesday, October 8, 2019
    Status: Full-time, Exempt: Yes SUMMARY:Development and maintenance of data  and formulas in rating tools. Lead on implementation of new tools and rating methodologies, including vendor communication. Ad hoc reporting as needed from both underwriting systems and companywide data  sources. Works with Actuarial to ensure updates to filings are implemented and tested  in quoting tools.  Works with FP&A to develop pricing for ancillary and ASO products. Provides training and assistance on data  rep ... More
  • Headquarters Office; Rochester Office
    Req #335
    Tuesday, October 8, 2019
    Status: Full-time, Exempt: Yes JOB SUMMARY   Responsible for the developing and conducting new employee Medicare product and on-going process training as well as remedial training for current staff including Medicare Sales representatives, IPAs, broker team, and Retail Outreach (cross-training) employees as needed. Training will include Medicare product, enrollment guidelines, process, benefit, and systems training.   Coordinates training plans and all on-going requests with Medicare Sale ... More
  • Headquarters Office
    Req #332
    Monday, October 7, 2019
    Associate, Credentialing Specialist_B Summary:Conducts verification of and processes credentialing and recredentialing applications of providers and organizational facilities in accordance with MVP Policies, NCQA standards, CMS, NYS Department of Health and other regulatory agencies. Processes Credentialing and Recredentialing Applications for practitioners and organizational providers including preparing files for the MVP Credentials Committee. Conducts primary source verifications from various ... More
  • Headquarters Office
    Req #323
    Monday, October 7, 2019
    Status: Full-time, Exempt       Reporting to the Sr. Leader, Claims Payment Strategies and Configuration, the Leader, Pricing & Claims Configuration manages the design, development and implementation of configuration solutions that enhance business processes. The Leader supervises a staff of Professional Configuration Analysts and manages the work intake, prioritization, assignment and tracking of all pricing/claims configuration projects and requests. In addition, the Leader is responsible to ... More
  • Schenectady, NY, US
    Req #314
    Wednesday, October 2, 2019
    This role will help advance Network Performance for MVP Health Care. The individual will be the lead data strategist responsible for evaluating Network Programs, including VBP and APM arrangements, and the overall performance of MVP Network Provider Partners. This individual will support the identification and selection of relevant clinical, financial and administrative information to share with and acquire from provider partners in value-based agreements. Along with his/her team, this individua ... More
  • Fishkill Office
    Req #318
    Tuesday, October 1, 2019
    Associate, Outreach Representative - Mid-Hudson Area  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 Qualifi ... More
  • Headquarters Office
    Req #315
    Tuesday, October 1, 2019
    Status: Full-time, Exempt          Summary: Responsible for leading the day-to-day operations of the Marketplace Enrollment Operations Team; MVP supports two state-based Marketplaces in New York and Vermont. This leader will oversee the all enrollment functions for the following New York State of Health Marketplace plans - QHP (Individual) and Essential Plan and also the QHP (Individual) plans on the Vermont Health Connect Exchange. Leads the day-to-day operation ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #321
    Monday, September 30, 2019
    Provides clinical expertise and timely first and second level clinical determinations based on MVP’s policies/procedures, state and federal guidelines, national accreditation standards, benefits interpretations, and other medical necessity criteria as necessary. Supports MVP’s efforts to enhance business discipline of and collaboration between Utilization Management, Case Management, Appeals and other divisions of the Health Management Department to improve clinical outcomes across all business ... More
  • Headquarters Office
    Req #185
    Monday, September 30, 2019
    Status: Full-time, Non-Exempt           Summary: This position main areas of responsibility are to ensure the accurate and timely processing of existing employer group changes and entry of new groups into Facets and the Employer Group Crosswalk (MVP Intranet). Applicants must possess a high working knowledge of Facets, and how Employer Groups, Products, Billing and Eligibility inter-relate within Facets. Process new groups, renewals, cancelations, ter ... More
  • Headquarters Office; Rochester Office
    Req #246
    Monday, September 30, 2019
        Status: Full-time, Exempt: No     Summary: This position will help licensed pharmacists take care of many of the daily operations of the pharmacy department. Including, but not limited: Calling Providers, members, and pharmacies. Providing drug-related information to Customer Care Center and other internal departments. Managing incoming faxes requesting drug coverage; Determining eligibility and pre-authorization necessity, obtaining additional information and initiating cases for revi ... More
  • Headquarters Office
    Req #313
    Monday, September 30, 2019
    Professional, IT Governance & SharePoint AnalystBe part of the transformation at MVP Healthcare. MVP Healthcare is a nationally-recognized, regional not-for-profit health plan. We care formore than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,600 employees. IT & Transformation Services (IT & TS), as a service-optimized IT organization, is focused on delivering business value to our customers and are continually evolving the way MVP uses techn ... More
  • Headquarters Office; Rochester Office
    Req #306
    Thursday, September 26, 2019
    Professional, Marketing & Communications  SUMMARY:   MVP Health Care is seeking an experienced Marketing &Communications professional to join our team. We are looking for anenthusiastic, creative and driven individual to provide marketing andcommunication expertise to the business. The ideal candidate will need to havea strong understanding of traditional and digital marketing tactics with provenproject management skills. You will: Partner in the planning, development and implementation of the g ... More
  • Headquarters Office
    Req #296
    Thursday, September 26, 2019
    Premium Billing & Collections Associate, AR Status: Full-time, Exempt: No SummaryThe role is responsible for overseeing, reconciling, auditing and tracking of all assigned accounts which include Group accounts, Off Exchange Individuals, CHP (Child Health Plus), EP/QHP On-Exchange Individuals. Responsible for insuring that all premiums are collected in a timely manner from groups, members and government entities. Maintaining and ensuring that all appropriate accounts are being submitted to coll ... More
  • Headquarters Office
    Req #316
    Thursday, September 26, 2019
    Status: Full-time, Exempt      Summary: The Operations Program Manager will accomplish strategic objectives by leading multiple projects and initiatives. Responsibility for projects includes the direction, coordination, implementation, execution, controls and completion of project, while remaining aligned with strategy, commitments and goals of the organization. The Operations Program Manager has oversight of the purpose and status of the projects across Operations at MVP and can u ... More
  • Tarrytown Office
    Req #308
    Thursday, September 26, 2019
    Associate, Care Center Representative Medicaid   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. Pr ... More
  • Headquarters Office
    Req #309
    Thursday, September 26, 2019
    Professional, Stop Loss Nurse Case Management    This position is responsible for identifying and tracking diagnosis, prognosis, andpotential high costs for members triggering stop loss reporting specific tocarrier and group policy requirements. This involves creating, analyzing and reviewingmultiple internal and external (i.e. ASO vendor reports) reports.  Communicates with stop loss carriers to correlate medical expense expectations to renewal quotes and member specific deductibles on renewal ... More
  • Headquarters Office
    Req #312
    Thursday, September 26, 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
  • Rochester, NY, US
    Req #297
    Tuesday, September 24, 2019
    This position is a critical role within MVP, supporting the successful transition of our participating providers to Value-Based Payment (VBP) and the achievement of the triple aim. PHMP professionals will be assigned to support the Regional VBP Leaders and the management of relationships and VBP contracting efforts with MVP’s strategic provider network partners in order to realize quality goals; support care coordination of patients; address social determinants of health; support integration of ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #303
    Monday, September 23, 2019
    Full-Time, Exempt Summary: This role will work closely with all departments implementing and ensuring the CRM tool-set works effectively across teams while maximizing efficiency and capitalizing on the full features and benefits of the Dynamics platform. Participate in planning, organizing and management of all CRM applications projects to ensure effective operations. Monitor CRM processes, resolving issues that arise in the execution of campaigns & workflows. Identify areas for improvemen ... More
  • Headquarters Office; Rochester Office
    Req #278
    Monday, September 23, 2019
    Professional, Mktg & Comm, Internal & Corp  This position works as part of an integrated team designedto provide cross-functional communication and marketing expertise to thebusiness with a focus on communicating with employees at all levels of theorganization, as well as corporate constituents. Overall team objectivesinclude, but are not limited to: identifying, developing, and utilizing themost appropriate communication vehicle(s) to reach the targeted audience; creating,planning, and provi ... More
  • Headquarters Office
    Req #292
    Friday, September 20, 2019
    Professional, Client Support       Summary: This position serves to provide day-to-day support to the commercial large group sales and account management team. Specific responsibilities include: daily sales, renewal, and administrative support for large group new sales and client engagement teams, proposal support, rate quote preparation, assistance with preparing reports and presentation material. Resolution, including monitoring and tracking, of broker and client issue ... More