Remote Core Systems & Provider Configuration Specialist

MetroPlus; New York (NY); On-site; USD 120,000 - 150,000; Full time

Job summary

MetroPlusHealth in New York seeks a Core Operations Manager to evaluate and optimize Core Systems and Applications across payer processes. You will collaborate with Provider Contracting, Credentialing, Claims Operations, Utilization Management, Network Management and external vendors to design and deliver system configurations that meet business needs.

The role requires 5–7 years in healthcare payer systems, strong PM and stakeholder management, and a track record of driving operational

Qualifications

• Must have a bachelor's degree in Information Systems/MIS, CS, Software Engineering, Health Information Management or Business Administration (Operations, IT or Healthcare focus).
• 5-7 years' experience in healthcare payer systems (claims processing & benefit configuration).
• Project Management and staff supervision experience is a plus.

Responsibilities

• Evaluate operational processes and improve MetroPlusHealth Core Systems and Applications.
• Track performance related to Core systems and vendors (claims processing, provider setup, benefit configuration, AP workflows).
• Manage and support business initiatives related to Core systems within budgetary objectives.
• Ensure initiatives/resolutions stay on track using Jira and ServiceNow.
• Review SLA performance and escalate concerns to leadership or vendor management teams.
• Coordinate with Claims Operations, Utilization Management and Network Management for use cases in system configuration.
• Identify inefficiencies and present improvement opportunities to leaders.
• Maintain visibility into system edits and advise on needed adjustments.

Skills

Integrity and Trust

Customer Focus

Functional/Technical skills

Written/Oral Communication

Education

Bachelor's degree (Info Systems / MIS, CS or Software Eng, HIM, or Business Admin)

Job description

MetroPlusHealth in New York seeks a Core Operations Manager to evaluate and optimize Core Systems and Applications across payer processes. You will collaborate with Provider Contracting, Credentialing, Claims Operations, Utilization Management, Network Management and external vendors to design and deliver system configurations that meet business needs.

The role requires 5–7 years in healthcare payer systems, strong PM and stakeholder management, and a track record of driving operational