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 purpose of this position is to provide financial analysis related to the provision, payment, and reporting of health care services. The position is also responsible for research, collection, analysis and presentation of the Plan's utilization and financial data. Candidates interested must work with multiple departments within the Plan to coordinate analytics to enhance operational efficiencies. Reports to Senior Director of Finance & Regulatory Reporting.

Job Description

• Responsible for maintaining and updating the MetroPlusHealth Reporting Data Categorization logic that is used for MMCOR (Medicaid Managed Care Operating Report) Reporting and EIS (Encounter Intake System) Reconciliation.
• Responsible for the completion of NY State Mandated Encounter Data to Cost Report Reconciliation Supplemental E and all supporting documentation.
• Responsible for the routine monthly internal claim line assessment of NY State data categorization reconciliation to MetroPlusHealth data categorization to analyze, identify and rectify gaps and inconsistencies.
• Responsible for ensuring reconciliations meet NY State standards.
• Responsible for reconciling and resolving differences between MetroPlusHealth data and general ledger.
• Responsible for score card oversight - Encounter Data Quality Performance Measures.
• Responsible for the monitoring of encounter data submission to ensure expected outcomes.
• Responsible for being State liaison to ensure alignment to NYS Encounter expectations.
• Responsible for monthly Unpaid Claims Liability data collection, reconciliation and submission to MetroPlusHealth's actuaries.

Minimum Qualifications

• Bachelor's degree with a minimum of 7 years of experience Industry related (business, health care, consulting, insurance, government).
• Health Insurance financial and data experience is necessary.
• Proficiency in Microsoft Excel, Access and Word are necessary.
• Excellent data analysis skills in SQL Server Environment are necessary.
• Experience with statistical systems and data report writers.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Strong Analytical and Problem-Solving Skills
• Excellent verbal, written and mathematical skills.

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