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  • Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #399
    Tuesday, November 12, 2019
    Professional, Behavioral HealthJob Summary  This position makes triage and referral decisions requiring clinical judgement.   The individuals will follow members for mental health, substance abuse and co-morbid medical disorders according to the benefit guidelines and policies across the continuum of care.  The individual will review all requests for inpatient services in view of the Appropriate BH and MVP standards, such as Interqual and LOCADTR guidelines, assuring that appropriate follow up ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #334
    Monday, November 11, 2019
    Associate, Credentialing Specialist  Summary: Conducts verification of and processes credentialing and recredentialing applications of providers and organizational facilities in accordance with MVP Policies, NCQA standards, CMS, NYS Department of Health and other regulatory agencies. Processes Credentialing and Recredentialing Applications for practitioners and organizational providers including preparing files for the MVP Credentials Committee. Conducts primary source verifications from v ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #395
    Monday, November 11, 2019
    RESPONSIBILITIES:MVPHealth Care’s internal well-being program, ourMVP Well-Being, strives to createthe healthiest workforce in the United States by creating solutions and asupportive environment to engage and educate coworkers to improve and maintainoptimal well-being. Our 2020 strategic plan has several exciting goals andobjectives that we hope to achieve. The program intern would help support anumber of those goals and would have the opportunity to assist in and take thelead of many different ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #389
    Monday, November 11, 2019
    This role will be responsible for ensuring great member and provider experience by accurately and efficiently processing claims adjustments, while concentrating on putting our customers at the center of how Operations operates. Ensures accurate and timely processing of claim adjustments/service forms and ad-hoc projects/retro database items in accordance with medical and ancillary guidelines and benefits. Acts as a liaison with other department and outside vendors to resolve claim issues as they ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #384
    Friday, November 8, 2019
    Status: Full-time, Exempt          Summary: This position supports the Leader of Operational support in facilitating, fostering and driving a sophisticated level of engagement activities and core competencies for both internal and external customers of MVP’s Claims department with outcome measures that focus on the member and provider experience. The role will provide oversight and direction in the duties of monitoring attendance, personnel issues, ... More
  • Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #388
    Wednesday, November 6, 2019
    Associate, Care Center Representative Medicaid   SUMMARY: Provides optimum customer service as required to maintain existing members and prevent cancellations. The Care Center Representative must take full responsibility for every call to ensurecallers concerns are met. Provides world class customer care to internal and external customers while consistently adhering to all call handling objectives, i.e. hold time, talk time, after call work, schedule adhere and quality assurance. Correctly r ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #380
    Wednesday, November 6, 2019
    Status: Full-time, Exempt: Yes       This position will provide direct oversight of Clinical compliance activities, including delegation oversight functions, for Health Management departments. This encompasses Utilization Management, Behavioral Health, and Case Management, with expected future expansion into Appeals and Pharmacy. This individual will be the point person for effectively communicating clinical regulatory and accreditation changes or updates and providing education to Heal ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #186
    Wednesday, November 6, 2019
    Status: Full-time, Exempt: No            Summary:  This position will serve as the first point of contact to members identified for MVP’s Integrated Medical/Behavioral Care Management Programs. As the first point of contact for these programs, the responsibility for efficient, customer service-oriented telephone interface is paramount. The Patient Engagement Specialist will: Lead efforts to locate and engage new and previously hard-to-engage members. This individual works to overcome lang ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #317
    Tuesday, November 5, 2019
    This role will be responsible for ensuring great member and provider experience by accurately and efficiently processing claims adjustments, while concentrating on putting our customers at the center of how Operations operates. Ensures accurate and timely processing of claim adjustments/service forms and ad-hoc projects/retro database items in accordance with medical and ancillary guidelines and benefits. Acts as a liaison with other department and outside vendors to resolve claim issues as they ... More
  • Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #367
    Tuesday, November 5, 2019
    Full-Time, Non-ExemptUsing a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. Is responsible for the timely and accurate adjudication ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #377
    Tuesday, November 5, 2019
    Status: Full-time, Non-Exempt            Summary: Primarily responsible for the entry, management, verification and reporting of the MVP participating and non-participating provider data, with the objective of keeping all information relating to these providers accurate and up to date enabling accurate and timely payment of claims, accurate marketing and reporting, and effective recruitment of physicians. This includes daily data entry or updating of information in Cactus and/or Facets ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #382
    Friday, November 1, 2019
    This is a great opportunity to join a fast-paced and collaborative HR team focused on supporting the organization attract, hire, retain and develop the best talent in the region.  The Professional, Talent Acquisition is responsible for the recruitment of a qualified and diverse pool of candidates for assigned departments. Provides support and guidance to hiring managers in the sourcing, selection and hiring process. Partners with assigned departments to provide support and guidance regarding t ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #347
    Thursday, October 31, 2019
    Status: Full-time, Exempt: No This position is responsible for addressing member/subscriber/provider inquiries, questions and concerns in areas including enrollment, claims, benefit interpretation, and referrals/ authorizations. Most of your day will be spent making contact by telephone.  You also may have some in-office contact and written correspondence/ e-mail with our customers as needed. Representatives may handle a variety of insurance types including HMO, POS, PPO, ASO, Indemnity, N ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #338
    Thursday, October 31, 2019
    JOB SUMMARY:             Conducts verification of the credentialing and recredentialing applications of providers and organizational facilities in accordance with MVP Policies, NCQA standards, CMS, NYS Department of Health and other regulatory agencies.     ESSENTIAL JOB FUNCTIONS:    Downloads applications from CAQH, as necessary.  Conducts all required primary source verification for applications including but not limited to Credentialing, Recredentialing, OngoingMonitoring, PSCR and ... More
  • Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #368
    Thursday, October 31, 2019
    Associate, Outreach Representative      Summary: The Outreach Representative conducts individual and group Field Outreach activities throughout their regions; promotes MVP throughout their regions, and conducts public presentations on MVP products. The Outreach Representative must provide fair and impartial information to individual Marketplace customers regarding coverage options available through the NY State of Health Marketplace. They help facilitate enrollment in Qu ... More
  • Fishkill Office, 300 Westage Business Center Drive, Fishkill, NY, USA
    Req #369
    Thursday, October 31, 2019
        Summary: The Outreach Representative conducts individual and group Field Outreach activities throughout their regions; promotes MVP throughout their regions, and conducts public presentations on MVP products. The Outreach Representative must provide fair and impartial information to individual Marketplace customers regarding coverage options available through the NY State of Health Marketplace. They help facilitate enrollment in Qualified Health Plans (QHPs), insura ... More
  • Utica Office, 419-421 Broad Street, Utica, NY, USA
    Req #359
    Thursday, October 31, 2019
    Associate, Outreach Representative    Summary: The Outreach Representative conducts individual and group Field Outreach activities throughout their regions; promotes MVP throughout their regions, and conducts public presentations on MVP products. The Outreach Representative must provide fair and impartial information to individual Marketplace customers regarding coverage options available through the NY State of Health Marketplace. They help facilitate enrollment in Qualified ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #335
    Wednesday, October 30, 2019
    SUMMARY:Responsible for developing a structure, reference content repository and quality standards of training to successfully conduct new employee Medicare product and on-going process training as well as remedial training for current staff including Medicare Sales representatives, IPAs, broker partners, and Retail Outreach (cross-training) employees as needed. Training will include content and job aids for Medicare product, enrollment guidelines, process, benefit, and systems. Coordinate ... More
  • Fishkill Office, 300 Westage Business Center Drive, Fishkill, NY, USA
    Req #374
    Wednesday, October 30, 2019
    Associate, Provider Based Outreach Representative   The Outreach Representative conducts provider Based Field Outreach activities throughout their regions; promotes MVP throughout their regions, and conducts public presentations on MVP products. The Outreach Representative must provide fair and impartial information to individual Marketplace customers regarding coverage options available through the NY State of Health Marketplace. They help facilitate enrollment in Qualified Health Plans (QHPs) ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #360
    Wednesday, October 30, 2019
    Status: Full-time, Exempt: Yes SummaryThis role is responsible for monthly investment processing, reporting and reconciliation; preparation of investment schedules for NAIC quarterly and annual filings;  processing  electronic funds transfers and preparing daily cash  position reports and forecasts; preparation and review of monthly bank reconciliations; assisting with system upgrades; assisting with internal and external audits;  implementing policies and procedures;  performing  other duties ... More
  • 625 State St, Schenectady, NY 12305, USA
    Req #375
    Tuesday, October 29, 2019
    Associate, Contract Analyst_B  OB SUMMARY: Under the direction of the Leader, Professional Relations the Contract Analyst is responsible to: Have a working knowledge of physician payments and reimbursements;  Ability to determine the appropriate contract and fee schedule for a potential provider applicant. Process new provider contract requests including medical, ancillary and behavioral health; Prepare CAQH applications and documentation and ensure effectiveness of the flow of informati ... More
  • Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #365
    Tuesday, October 29, 2019
    Status: Full-time, Non-Exempt           Summary: Investigate, monitor and review other group health coverage that may be primary over MVP plans through various reports and online methods including inbound/outbound calls. Updating and documenting all COB information into member’s records with information obtained from the investigations and research including other insurance effective/terminated dates, type of coverage, accident dates, diagnosis for related injury and any other informati ... More
  • 625 State St, Schenectady, NY 12305, USA
    Req #330
    Friday, October 25, 2019
    JOB SUMMARY: Under the direction of the Leader, Professional Relations the Contract Analyst is responsible to: Have a working knowledge of physician payments and reimbursements;  Ability to determine the appropriate contract and fee schedule for a potential provider applicant. Process new provider contract requests including medical, ancillary and behavioral health; Prepare CAQH applications and documentation and ensure effectiveness of the flow of information from Credentialing throug ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #356
    Friday, October 25, 2019
    This position is responsible for leading an integrated team designed to provide cross-functional communication and marketing expertise that support the growth and retention of our membership. Responsibilities include developing and implementing initiatives and integrated communication plans and marketing solutions in support of the assigned line of business (Medicare, Medicaid). Responsible for a wide variety of marketing and communication functions and leverages consumer insights for strategic ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #301
    Friday, October 25, 2019
    Status: Full-time, Exempt: NoSummary:This role is responsible for all lines of business inpatient claims queue work. Reviews incorrect claims for inpatient/outpatient services. May review DME and Case Management claims. Is responsible for the Retro Review process as it pertains to medical record requests and processing incoming charts. Responsible for DRG and Retrospective Review record requests to appropriate hospitals. Knows and interprets the MVP benefits program, policies and protocols. Is r ... More