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  • Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #535
    Thursday, May 21, 2020
    Status: Full-time, Exempt: No  Summary: Identifies, collects, assesses, monitors and documents claim and encounter coding information as it pertains to CMS Hierarchical Condition Categories (HCC). Actively participates in and supports the Medicare Risk Adjustment team-based environment to educate providers on coding compliance and consistency. Works with the Coding Leader of Medicare Risk Adjustment to ensure coding compliance and appropriate reimbursement from CMS. Performs other duties as as ... More
  • Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #547
    Tuesday, May 19, 2020
    Under the direction of the Supervisor, Customer Care:  Senior Customer Care Representative (SCCR) position has broad range of on and off call responsibilities. On call responsibilities includes responding to customer inquiries in areas of enrollment, billing, claims, benefit interpretation, and referrals/authorizations for medical care. The majority of contacts are via telephone, with some in-office contact and written correspondence/e-mail and chat. May handle a variety of insurance ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA; Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #545
    Tuesday, May 19, 2020
    Status: Full-time, Exempt: Yes The Quality Management (QM) Behavioral Health (BH) Liaison will, along with internal and external stakeholders, assess the clinical and service needs of MVP Health Care members with behavioral health (BH) conditions. The QM BH Liaison will work directly with regulators (DOH, OMH) and BH clinical area for the child populations including medically fragile children, children in foster care, and have strong knowledge of the community and family-based services and ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA; Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA; Virtual
    Req #543
    Monday, May 18, 2020
    Status: Full-time, Exempt: Yes    Provides clinical expertise and timely first and second level clinical utilization management determinations based on MVP’s policies/procedures, state and federal guidelines, national accreditation standards, benefits interpretations, and other medical necessity criteria as necessary.  Lead’s MVP’s efforts to collaborate in person and virtually with behavioral health network providers and facilities around clinical determinations, policy interpretation, sharing ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #540
    Wednesday, May 13, 2020
    Professional, Underwriting Status: Full-time, Exempt: Yes SUMMARY The Underwriter will analyze large accounts for group quote determination in accordance with MVP’s filed rates and methodologies as well as manage the experience rated block of business to produce desired MLR and profit targets. In addition, the underwriter provides support for the sales and account management teams regarding group renewals and prospects, including strategy, product offerings, data review, and mana ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #482
    Tuesday, May 5, 2020
    Legal Counsel   JOB SUMMARY: Under the direction of the Managing Counsel, provides legal advice and business counsel to the Company’s operational units in variety of subject areas, including litigation/dispute resolution, special investigations, Medicare administrative hearings, commercial products and administrative service only plans. Drafts and negotiates procurement agreements, service agreements, HIPAA business associate agreements, and confidentiality/non-disclosu ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #538
    Friday, May 1, 2020
    Sr Leader, Actuarial, Medicare Status: Full-time, Exempt: Yes Primarily Remote position not required to re-locate, however, on occasion, must be available to commute to Schenectady and/or Rochester for team meetings or as required.   Summary:The Actuary will lead a team of analysts in managing all responsibilities related to setting and filing CMS Bids for Medicare Direct Bill as well as setting premium rates / factors and experience rating methodologies for the Medicare Employer Group Market. ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #437
    Monday, April 27, 2020
      This position will report to the Senior Leader, Enterprise Risk Management (ERM) and oversee MVP’s business continuity management activities necessary to keep the business running effectively and efficiently during and after a disruptive event. As part of the ERM team, the incumbent may also assist with other risk management activities.   The role includes but is not limited to the following:   Scale and maintain a BCM program that aligns to industry ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA; Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #537
    Friday, April 24, 2020
    Status: Full-time, Exempt: No   Summary: Analyzes and provides coding review with recommendations for processing and payment of outpatient and surgical claims rendered by participating and non-participating physicians. Reviews claim modifiers and responds to correspondence and telephone calls from  physicians and/or their staff. Processes multiple levels of appeals for all of the medical staff. Assists with the development and refinement of policies and procedures as ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #484
    Thursday, April 23, 2020
    Status: Full-time, ExemptSummary:This role is responsible for developing reports and analysis for consumption by internal and external department customers using a variety of company data sources in support of the information requirements for the Operations Department including Claims, Member services, and Managed Care Systems areas. Presents and explains results of analyses internally and externally. Architect, design, implement, and support a platform providing secured access to large datasets ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #516
    Monday, April 20, 2020
    Associate, Accounts ReceivableSummary: The role is responsible for overseeing, reconciling, auditing and tracking of all assigned accounts which include Group accounts, Off Exchange Individuals, CHP (Child Health Plus), EP/QHP On-Exchange Individuals. Responsible for insuring that all premiums are collected in a timely manner from groups, members and government entities. Maintaining and ensuring that all appropriate accounts are being submitted to c ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #526
    Friday, April 17, 2020
    Status: Flexible, Exempt: No Timeframe Job Available: Summer (May – August) 2020 The Enterprise Information Security Intern is responsible for assisting the CISO with many components of the institution's information security program. Must be available 15+ hours each week.  Duties and responsibilities can include: Review and update documentation for policies, procedures, standards and guidelines. Research and evaluate applications and services for use by t ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA; Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA; Virtual
    Req #530
    Friday, April 17, 2020
    Status: Full-time, Exempt: Yes    Enterprise Solutions Architect-Digital Products Be a part of the transformation at MVP Healthcare.  MVP Healthcare is a nationally-recognized, regional not-for-profit health plan.  We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,600 employees.   We are continually evolving the way MVP uses technology to grow our business, digitally transforming the or ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #517
    Friday, April 10, 2020
    Full-Time, Non-Exempt   This position serves under the Marketplace Enrollment Team working in the exchanges market serving New York State of Health (NYSOH) and Vermont Health Connect (VHC). This position is responsible for the team’s daily workload which includes verifying, entering and correcting enrollment data using multiple software systems. Responsible for communicating between both internal and external clients for any eligibility inquires or discrepancies. Provides analytical review of ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #521
    Thursday, April 9, 2020
    Full-Time, Exempt Be part of the transformation at MVP Healthcare. MVP Healthcare is a nationally-recognized,regional not-for-profit health plan. We care for more than 700,000 membersacross New York and Vermont and are powered by the ideas and energy of morethan 1,600 employees.   IT & Transformation Services (IT & TS), as a service-optimized IT organization, is focused on delivering business value to our customers and are continually evolving the way MVP uses technology to grow our business. ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #475
    Thursday, April 2, 2020
      Status: Full-time, Exempt: Yes   MVP Information Services business unit is seeking a highly motivated – detail-oriented candidate for the position of Physical Security Manager. This position is responsible for all aspects of MVP’s physical security infrastructure and services. The successful candidate should be an independent thinker with excellent organizational skills and an ability to prioritize multiple demands in an aggressive paced environment.     The role includ ... More
  • Fishkill Retail Outreach, 300 Westage Business Center Drive, Fishkill, NY, USA; Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA; Syracuse Office, 333 West Washington St, Syracuse, NY, USA; Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA; Virtual
    Req #428
    Thursday, April 2, 2020
    Status: Full-time, Exempt: Yes The Behavioral Health (UM for Autism Spectrum Services) makes triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD). The individual will follow members for mental health, substance use 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 an ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #489
    Tuesday, March 24, 2020
    Status: Full-time, Exempt: YesThe Quality Engineer is a critical part of this transformation.  As a member of a Scrum team, the Quality Engineer is primarily responsible for that ensuring quality products are delivered to the organization. The candidate will work with a cross-functional team to understand business requirements and break them into user stories, develop test plans, test cases and execute test scenarios to ensure we are delivering high quality code.  The ideal candidate is a highly ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #497
    Tuesday, March 17, 2020
    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; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #487
    Monday, March 16, 2020
    Status: Full-time, Exempt: Yes The Senior Quality Engineer is a critical part of this transformation.  As a member of a Scrum team, the Senior Quality Engineer is primarily responsible for ensuring that quality products are delivered to the organization. The candidate will work with across-functional team to understand business requirements and break them into user stories, develop test plans, test cases and execute test scenarios to ensure we are delivering high quality code.  The ideal cand ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #492
    Friday, March 13, 2020
    JOB TITLE:Marketing & Communications Intern (2 openings)STATUS:Full-timeNUMBER OF HOURS PER WEEK:37.5LOCATION(S):SchenectadyTIMEFRAME JOB AVAILABLE: Summer and Fall OptionsRESPONSIBILITIES:An internship with MVP’s Marketing & Communications department is a great way to gain exposure, experience, and a portfolio of work in a variety of marketing, communications, and advertising areas. During the internship, you will work side-by-side with many members of the Marketing & Communications team, suppo ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #496
    Thursday, March 12, 2020
    Full-Time, ExemptBe a part of the transformation at MVP Healthcare.MVP Healthcare is a nationally-recognized, regional not-for-profit health plan.We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,600 employees.We are continually evolving the way MVP uses technology to grow our business, transforming the organization through Cloud Computing, Agile Delivery, and DevOps. MVP Information Services business unit is seeking a highl ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #480
    Monday, March 9, 2020
    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 #483
    Friday, March 6, 2020
       Summary:   Prepares Financial Statements and detailed financial reporting for assigned companies and IPAs, PHO arrangements, when needed. Performs accounting duties and produces monthly reports and analytics for assigned companies. Identifies variances and financial trends for revenue and expense line items. Posts and tests assigned interfaces to general ledger. Reconciles IPA/HMO intercompany accounts. Performs bank account reconciliations and general ledger account reconcilia ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #477
    Monday, March 2, 2020
    Band level: Sr. Leader II    Status: Full-time, Exempt: Yes Referral Bonus: Standard Talent Acquisition Representative: Carolyn Vinci, CVinci@mvphealthcare.com       The Sr. Leader, Pharmacy Programs will be responsible for the oversight and coordination of the Pharmacy department programs to improve patient outcomes and manage the cost of pharmaceutical care.    Develop, implement, and manage clinical initiatives, including drug prior authorization and medication management programs ... More