Remote Healthcare Provider Configuration & Systems Analyst

MetroPlus; New York (NY); On-site; USD 110,000 - 150,000; Full time

Job summary

MetroPlusHealth is seeking a Core Operations Manager to evaluate and optimize Core Systems and Applications. You will partner with Provider Contracting, Credentialing, Claims Operations, Utilization Management, Network Management, and external stakeholders to align systems with business needs.

Lead initiatives, monitor performance using Jira and ServiceNow, review SLAs, and coordinate with vendors. Candidates should have a bachelor’s degree in a relevant field and 5–7 years of healthcare payer

Qualifications

• Must have a bachelor’s degree in Information Systems/MIS, Computer Science, Software Engineering, Health Information Management, or Business Administration (Operations, IT, or Healthcare focus).
• Must have at least 5-7 years’ experience in healthcare systems, specifically with payer systems such as claims processing and benefit configuration, provider data management, and systems testing/migration.
• Project Management and Staff Supervision a plus

Responsibilities

• Track and advise on performance of Core systems and vendors (claims processing, provider setup, benefit configuration, AP workflows).
• Manage and support business initiatives related to Core systems within budget objectives.
• Ensure initiatives stay on track using Jira and ServiceNow.
• Review SLA performance and escalate concerns to leadership or vendor teams.
• Direct and coordinate communication between business units and Core system vendors.
• Advise in new business and operational initiatives and guide current/future system capabilities.
• Collaborate with Claims Operations, Utilization Management, and Network Management to gather use cases for system configurations.
• Identify operational inefficiencies and present improvement opportunities.
• Track and coordinate responses to provider/State complaints.
• Maintain visibility into system edits and advise on adjustments.

Skills

Integrity and Trust

Customer Focus

Functional/Technical skills

Written/Oral Communication

Education

Bachelor's degree in Information Systems/MIS, Computer Science or Software Engineering, Health Information Management, or Business Administration (Operations, IT, or Healthcare focus)

Job description

MetroPlusHealth is seeking a Core Operations Manager to evaluate and optimize Core Systems and Applications. You will partner with Provider Contracting, Credentialing, Claims Operations, Utilization Management, Network Management, and external stakeholders to align systems with business needs.

Lead initiatives, monitor performance using Jira and ServiceNow, review SLAs, and coordinate with vendors. Candidates should have a bachelor’s degree in a relevant field and 5–7 years of healthcare payer