Senior Provider Configuration Lead - Claims & Reimbursement

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

Job summary

MetroPlusHealth is seeking a Senior Provider Configuration Analyst to configure systems for provider contracts and claims processing. You will maintain fee schedules, analyze requirements, and ensure system alignment with departmental needs.

Responsibilities include testing, system modification requests, migrations to HealthEdge HRP and Source, and data analysis with SQL. Collaboration with system consultants and cross-department escalation handling are key aspects of the role.

Qualifications

• A Baccalaureate Degree from an accredited college or university required; Computer Science preferred.
• Six (6) years of progressive experience in configuration for data processing, computer systems and applications.
• Experience with HealthEdge HRP and Source products required.
• Demonstrated experience supporting system configuration, workflow analysis, and technical documentation in a healthcare or claims environment.

Responsibilities

• Configure provider reimbursement and create and maintain fee schedules.
• Analyze departmental requirements to develop long and short-term plans.
• Ensure system processes are aligned with department needs.
• Analyze system to ensure claims are processed correctly to protect the company from liabilities.
• Collaborate with system consultants to correct errors, rectify omissions, and investigate system issues.
• Identify potential system problems for claims resolution.
• Review test cases to ensure alignment with requirements and assist with testing processes.
• Conduct ongoing reviews of systems and processes for accurate, optimal setup for provider and claims.
• Receive, coordinate, and manage requests for Systems Modifications.
• Maintain and track open issues and coordinate release testing.
• Assist with system migration to HealthEdge HRP and Source products.
• Run reports and perform analysis using SQL.
• Create and maintain an inventory of pricing templates and their contents.
• Monitor and manage Core Systems performance.
• Respond to escalated issues from various MetroPlusHealth departments.
• Perform and assist with other functions as required by the Director of Provider Contract Configuration.
• Participate in special projects and strategic initiatives as needed.

Skills

Integrity & Trust

Customer Focus

Functional/Technical skills

Written/Oral Communication

Independent work & prioritization

Education

Baccalaureate Degree (Computer Science preferred)

Tools

HealthEdge HRP

Source

Job description

MetroPlusHealth is seeking a Senior Provider Configuration Analyst to configure systems for provider contracts and claims processing. You will maintain fee schedules, analyze requirements, and ensure system alignment with departmental needs.

Responsibilities include testing, system modification requests, migrations to HealthEdge HRP and Source, and data analysis with SQL. Collaboration with system consultants and cross-department escalation handling are key aspects of the role.