Enrollment & Membership Data Integrity Supervisor

MetroPlus Health Plan 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, MetroPlus' network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

• Overall management of the day to day operation of the Data Integrity Unit within the Enrollment and Membership Department.
• Maintaining the accuracy and integrity of membership data for all lines of business.
• Ensure the timely review and processing of all rejected 834 enrollment.
• Ensure that all 834 enrollment issues are handled efficiently and within mandated time frames as required by our regulatory/contractual obligation.
• Work departmentally and interdepartmentally to identify defects; recommended and requests modifications to existing systems to improve departmental performance by supporting quality, operational efficiency.
• Oversight of enrollment and disenrollment applications within the HHC line of business
• Responsible for ensuring that all errors generated from the KIDS system, premium billing, (invoicing) and capitation payment are investigated and corrected in an accurate and timely fashion.
• Investigate and resolve complex Eligibility issues from other internal departments as they relate to current members ( MIS, Finance, Retention) as it relates to all lines business.
• KIDS system: Responsible for the disposition of the daily New York State Department of Health Inter-plan and Intra-plan CHP enrollment. Also, responsible for the disposition of the dually enrolled in CHP (daily) and Medicaid (monthly) report.
• Oversight of the processing of eligibility issues received via AWD from the claims department.
• Other Duties as assigned.

• Bachelor's Degree equivalent work and experience required
• Excellent verbal and written communications skills
• Excellent PC skills
• Excellent interpersonal skills
• Knowledge of (Medicaid, QHP, EP, CHPlus) Enrollment Policies
• Detail oriented with the ability to manage multiple assignments simultaneously
• Ability to apply critical thinking skills, ability to work around barriers, ability to work independently.
• Ability to change priorities, meet dead lines, and work well under pressure.

If you wish to apply for this position, please apply online by clicking the "Apply Now" button or forward your resume, noting the above Job ID #, to:

MetroPlus Health Plan
Human Resources Department
160 Water Street 8th Floor
New York, NY 10038
Attn: Recruitment Unit

This is position is classified as a managerial title, in addition to a variety options for Health Benefits through MetroPlus, managerial employees receive vision, dental, gym reimbursement and life insurance benefits through the Management Benefits fund of the City of New York. Please view the benefits page for more detailed information.

Company Description

MetroPlus provides access to health care services to New York City residents in Brooklyn, Queens, the Bronx and Manhattan through New York State's Medicaid Managed Care, Child Health Plus, Family Health Plus and Partnership in Care, an HIV Special Needs Program through its network of participating providers

Work location: New York, NY