MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
The Claims Compliance Remediation Analyst will support the Director of Claims Support to ensure claims rules, guidelines, documents, policies and procedures, reporting, job aides, training, and other key components are compliant with CMS and NYSDOH regulatory entities and maintained within a central repository. This incumbent will partner with the Office of Corporate Compliance to ensure that the Claims Department fully supports company objectives and requirements. The incumbent will also coordinate efforts with the Office of Corporate Compliance and represent the interest of the Claims Department before, during, and after regulatory audits (internal and external). This role is critical to the Claims Department by ensuring documents, workflows, and processes are up-to-date and compliant, reducing incorrect claims payments as well as reducing claim adjustment requests, thereby reducing both medical and administrative expenses.