Product Implementation Specialist at MetroPlus

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 Product Implementation Specialist will use their benefit and Product knowledge to prepare, monitor, and customize benefit changes or payment reimbursement requirements per regulatory guidance. They ensure a smooth benefit implementation based on the request from start through completion. To ensure this happens, they talk with internal business owners, collect data, customize required configuration forms, define objectives, and maintain corporate tracker. The Product Implementation Specialist will act as the point of contact for the company and initiate implementation processes as quickly as possible.

• Lead the regulatory implementations for NY State-Sponsored Programs and CMS Medicare lines of business.
• Manage the full project cycle of implementations from beginning to end.
• Analyze complex Product benefit configuration and rate implementation projects and build a range of meaningful recommendations.
• Use data and insights to inform conclusions and support decision making.
• Proactively gather information to understand business owner needs.
• Effectively communicate with all business partners including Core Systems, Medical Management, Business Operations, Regulatory and Compliance ensuring appropriate and timely updates to any potentially impacted departments.
• Review and verify documentation for compliance and operational accuracy.
• Assist with CPT code verification for benefit implementations ensuring proper configuration.
• Special projects and other related duties as assigned.

• Bachelor’s Degree required.
• Minimum 5 years of experience in health care, medical coding, product, regulatory, or other relevant field.
• Medical coding experience preferred.
• Project Management skills preferred.
• Working knowledge of Product department, implementations, system transformation and operational aspects of health care
• Experience or in-depth knowledge of HealthRules Payor system is a plus.
• Skills in Microsoft Excel, PowerPoint, and Word are required

Licensure and/or Certification Required

• Medical Coding Certification preferred

Professional Competencies

• Integrity and Trust
• Customer Focus
• Excellent verbal, written, mathematical, and interpersonal skills
• Able to work collaboratively and efficiently with multidisciplinary teams
• Highly detail-oriented
• Strong presentation skills

#LI-Hybrid