Provider Maintenance Supervisor

MetroPlusHealth; New York (NY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

MetroPlusHealth in New York, NY seeks a Provider Maintenance Supervisor to oversee daily staff activities and ensure accurate provider data management. You will collaborate with Claims, Provider Network Operations, UM, IT, Credentialing, and Provider Contracting while resolving escalated issues and improving processes.

The role requires a Bachelor’s degree and at least 2 years of supervisory experience, with preferred knowledge of HRP and MS Office applications.

Qualifications

• Bachelor’s Degree required.
• Minimum 2 years’ relevant supervisory experience required; or an equivalent combination of education, training and experience.
• Knowledge of HRP (Health Rules Payor) preferred.
• Familiarity with Word, Excel and Access preferred.

Responsibilities

• Supervise staff and provide day-to-day oversight of Provider Maintenance functions.
• Document departmental policies and procedures; create/modify user manuals.
• Monitor staff performance and conduct performance reviews.
• Assist in resolving escalated provider participation issues with leadership.
• Collaborate with Core Systems and Claims teams to update provider information and reflect changes.
• Plan and implement procedures to maximize operating efficiency.
• Address inquiries from multiple departments and external customers.
• Assist in 1099 reporting and in MedHome/Uploads/Communication Grid updates.

Skills

Supervisory experience

Integrity and Trust

Customer Focus

Technical skills

Excellent communication

Analytical

Education

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Job description

Position Overview

This position directly interfaces with the Claims, Provider Network Operations, UM, IT, Credentialing, and ProviderContracting Departments as well as internal/external customers. The incumbent will provide day-to-day supervision of staff and must be able to perform all Provider Maintenance Representative functions as needed.

Scope of Role & Responsibilities

• Document departmental policies and procedures.
• Create/modify departmental user manuals.
• Monitor staff performance including performance reviews.
• Assist in resolving escalated provider participation issues from the Manager of Provider Maintenance and senior management.
• Working closely with the Core Systems and Claims teams as well as SS&C. The incumbent will modify existing data to reflect updated provider information as needed.
• Determine the impact of requested changes to the providers and claims
• Assist requestor in determining the specifics of a given provider change request and assist and update to fulfill request.
• Plan and implement procedures and systems to maximize operating efficiency
• Address escalated inquiries from the Claims, Provider Network Operations, UM, IT, Credentialing, and Provider Contracting Departments as well as internal/external customers.
• Address daily emails received from internal and external customers.
• Assist in the 1099 reporting process
• Assist in MedHome/Uploads/Communication Grid updates, when needed
• Monitor and track activities related to the contract load process
• Perform system testing as it relates to claims processing and provider setup
• Develop processes as needed.

Required Education, Training & Professional Experience

• Bachelor’s Degree; and
• Minimum 2 years’ relevant supervisory experience required; or
• A satisfactory equivalent combination of education, training, and experience Docusign Envelope ID: D4377095-C3F7-84DF-802F-C2C26D6249CE
• Knowledge of Health Rules Payor (HRP), Word, Excel, and Access preferred

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Excellent oral and written communication skills.
• Analytical and problem-solving abilities.

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