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Maintenance Technician

MetroPlus Health Plan

This is a Full-time position in New York, NY posted June 7, 2021.

About NYC Health + Hospitals

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. 

Position Overview

This position directly interfaces with the Provider Contracting, Core Systems, Network Relations, Credentialing, Utilization Management, Claims, and the DST BPO. Incumbent will be responsible for creating and maintaining provider and vendor records for both Participating and Non-Participating Providers.

Job Description

  • Working closely with the Core Systems, MetroPlus Claims Department and the DST BPO, the incumbent will modify existing data to reflect updated provider information.
  • Review provider information submitted on electronically submitted on claim files.
  • Communicating with providers and vendors to secure supporting documents for creating and maintaining records.
  • Communicating with other MetroPlus departments to fulfill requests for changes or additions to provider and vendor records.
  • Communicating directly with the DST BPO Staff to address all provider file issues relative to Medicare, Marketplace and FIDA claims.
  • Documenting issues via DST ESupport System.
  • Working in AWD and or PowerStepp to address provider claims issues.
  • Participating in meetings to address critical issues regarding the MetroPlus Provider File.
  • Participating in System Testing as requested.
  • Other duties as required

Minimum Qualifications

  • Associates’ Degree or three years progressive experience in a healthcare setting.
  • Auditing experience in the collection and the analysis of data to detect deficient controls, duplicated effort, and non-compliance with department guidelines.
  • Demonstrated analytical and problem-solving abilities sufficient to effectively define complex problems and solutions in a logical and organized manner.
  • Excellent oral and written communication skills.
  • Proficiency in PowerStepp and MACESS.
  • Detail oriented with the ability to manage multiple assignments simultaneously.
  • Ability to adapt to changes in a fast paced environment.
  • Strong knowledge of Microsoft office tools.
  • Knowledge of managed care, health care systems and Medicaid valuable

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication