Behavioral Health

Title:currently there are no job openings at this department

Claims

Title:Claims Analyst (3)
Dept:   Claims
Grade:   4
Shift:   Monday – Friday 9:00am – 5:00pm
Location:  37th St
Date Posted:  8/13/10

Job Summary:
The Claims Analyst is responsible for the life cycle of claims. He/she will adjudicate claims using independent judgment, interpretation of Contracts, Medical Policy, Medical Management, Authorizations, and Historical Data.

Specific Duties and Responsibilities
1. Analyze and adjudicate pended claims generated from Rubi Reporting System
2. Research Health Plus member file when a discrepancy exists or eligibility is questioned
3. Analyzes claims to determine appropriate reimbursement for par and non-par providers
4. Analyzes claims by type of service interpreting Medical and Claim Policy and Procedures
5. Reviews provider refunds and applies adjustment workflows 
6. Responsible for the adjudication of complex claims for various types of service  
7. Refers claims with security restrictions and/or high dollar allowable to Senior Claims Analysts
8. Interacts with providers on the telephone or by correspondence, often dealing with Doctors, Medical Office Managers, Health Officials, Hospital Billing Management, and Billing Services
9. Determines NYS member eligibility using EMEV
10. Document and track claim inquiries using Customer Focus
11. Review correspondence to determine post payment accuracy
12. Maintains all documentation for claims processing reference manuals

Required Skills and Experience:
• Strong data entry skills (10,000 keys strokes alpha/numerical)
• Must be able to work independently
• Must be able to exercise judgment
• Must be able to interact with providers in a professional manner and be capable of high professional levels of communication
• Must be able to work on computer systems, accessing multiple files
• Claims processing, medical billing or related work skills required
• Knowledge of medicine and medical terminology, CPT and ICD.9 and DSM codes.
• Must have good mathematical skills to maintain and monitor batch controls and
• Calculate payments and provide other statistical data
• Must be able to work under general guidance of Claims Supervisor and Sr. Claims Analyst with little direct supervision
• Must be meticulous and pay attention to detail
• 1yr - Prior Medical Claims processing or billing experience
• Customer Service experience

Required Education
• High School Graduate,
• Some college preferred

Compliance / Regulatory Affairs

Title:Senior Compliance Auditor
Dept:  Compliance / Regulatory
Grade: 8
Shift:   Monday – Friday days
Location: Adams St
Date Posted: 8/20/10

Job Summary:
Responsible for providing oversight of Corporate Audit Work Plan and related compliance activities. Test controls to ensure conformance with State and Federal regulatory requirements, Health Plus standards, applicable statements of policy and procedures, sound principles of internal control, and in a manner consistent with both company and high standards of administrative practice. Essential duties to include, but are not limited to:

Primary Duties  & Responsibilities:
1. Participating with the Director in evaluating the adequacy and effectiveness of internal controls for compliance with regulatory requirements.
2. Review documentation and test internal controls of various departments, with emphasis identified regulatory and compliance risk areas.
3. Plans and conducts independent appraisals of the effectiveness of Health Plus procedures and standards.
4. Establish internal policies and procedures for Audit Unit.
5. Interacting with appropriate members of management during the course of the audit and in reporting conclusions.
6. Prepares and submits reports on the results of testing, identifying control deficiencies, developing remediation plans, issuing recommendation to operational areas and conducts fraud investigation follow-up audits, including enrollment, and marketing.
7. Performing follow up audits to ensure that operational areas comply with implemented plans of corrections resulting from external audit findings.
8. Oversees an ongoing monitoring of marketing/ enrollment reviews and targeted audits related to investigations of compliance issues
9. Informing the Director in a timely manner of any potential problems in situations that may require direction or input.
10. Makes recommendations on the systems and procedures under review; provides on-going follow-up reporting to monitor management response and implementation.
11. Conducts an annual corporate-wide risk assessment.
12. Performs other duties as assigned.

Required Skills and Experience:
1.   Corporate operations, financial and/or compliance audit experience with some technology   audit knowledge.
2.   Financial Accounting understanding considered a plus;
3.  Minimum two years paid employment as an internal health care auditor.
4.  Thorough knowledge of audit procedures, including planning, data gathering techniques, test and sampling methods.
5.  Ability to analyze and evaluate findings and to prepare and present concise and clear written reports.
6.  Strong project management skills.
7. Excellent written and oral communication skills.
8. Proficiency in Microsoft applications (Word, Excel, Power Point, Access).

Required Education:
1.   Bachelor’s Degree with a concentration in finance/accounting and audit
2.  Certification including one or more of: CIA, CFE(Certified Fraud Examiner) or AHFI (Accredited Health Care Fraud Examiner), are a plus but not required

Title:Medicare Analyst
Dept:   Compliance/ Regulatory Affairs
Grade:   8
Shift:   Days
Location:  335 Adams Street
Date Posted:  6/25/10

Job Summary:
The Medicare Compliance Analyst provides professional support to the Vice President Compliance/ Regulatory Affairs and works with Health Plus staff to ensure that the Health Plus Elite program complies with applicable regulations and meets operational requirements. 
The Medical Compliance Analyst will also assist in planning and implementation for compliance with Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules and will assist in assessing and documenting compliance. 

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: 
• Maintains the Medicare Advantage and Part D compliance program and related regulatory oversight activities.
• Prepares annual Medicare Advantage and Part D Compliance Program to reflect changes in Federal and State regulations.
• Monitors CMS regulations as well as applicable State insurance laws and regulations and provides direction for and expertise in Medicare Advantage Part to ensure administrative and operational activities comply with regulations.
• Reviews HMPS communications daily and ensures appropriate distribution of information and follow-up actions
• Oversees Part D Compliance and is liaison with PBM on compliance program and issues
• Coordinates and prepares operations for regulatory and other internal audits.
• Conducts periodic "mock" audits to evaluate compliance; proposes corrective action and monitors implementation of corrective action.
• Documents compliance activities and maintains a file with appropriate evidence of compliance.
• Develops and implements standardized regulatory compliance tools as needed.
• Promote Medicare compliance awareness throughout the company and its key business partners.
• Assists in the development of a Medicare training curriculum.
• Ensure that all required regulatory filings and responses are timely, accurate
• Act as a liaison and primary point of contact with the Centers for Medicare & Medicaid Services (CMS) regional/central offices for the resolution of compliance issues.
• Manage all CMS audits/site visits. Develop corrective action plans to remediate audit findings and monitor operational department’s implementation of such plans.
HIPAA Compliance Functions:
• Monitors and ensures HIPAA compliance through oversight of office site visits, periodic internal reviews, training and education
• Keeps current on HIPAA and privacy regulations and responds to staff inquiries
• Follows up on reported issues and inappropriate disclosures of PHI.
• Special projects and work assigned by supervisor. 

Required Education & Skills:
BA/BS required.
Strong working knowledge of Medicare Advantage and Medicare Part D regulatory requirements is mandatory.
Strong working knowledge of compliance principles, practices, and procedures
Excellent interpersonal and computer skills
Strong verbal and written communications skills
Well-developed management skills are necessary

Required Experience:
Minimum 3 years of recent experience in a compliance-related role with a health care organization or health insurer

Enrollment

Title:Enrollment Representative
Dept:  Enrollment
Grade:  3
Location: 37th Street
Shift:  Monday – Friday 9:00am – 5:00pm
Date Posted: 7/16/10

Job Summary:
 The Enrollment Representative is responsible for assuring that all new applications for Health care Plus, Child Health Plus, Child Health Plus re-certification and Family Health Plus applications are complete and accurate.
Principal Duties and Responsibilities:  *Essential Functions
Reviews all new Health Plus and Child Health Plus initial applications and re-certifications for complete and accurate information.
Reviews documents provided with the application for appropriateness in accordance with New York State guidelines.
Batches and prepares all applications for data entry.
Performs data entry of applications in Health Plus submission database.
Assists the enrollment supervisor in reviewing data entry error reports.
Verifies if applicant is Health Plus member.
Quality checks documentation for proofs.
Quality checks applications for completion verifying documentation for returns.
Files application/disenrollment forms/documents for applications.
Follows up with Representatives.
Interacts with Member Services to resolve problems.
Proof reads application and recerts for accuracy.
Checks emevs for Medicaid eligibility.
Checks and enters application for presumptives then files applications.
Calls members to verify presumptive documents.
Responsible for mailing out letters to remind members that documentation is due before cut-off date.
Follows up with representatives to inform them presumptive documents are submitted on time before member is disenrolled.

Job Specification:
• Excellent verbal and written communication skills
• Must be able to work independently with little supervision

Required Education and Experience:
• High School diploma or equivalent.
• Prior health care, clerical and data entry skills are necessary.
• Ability to type 40 w.p.m.

Executive Office

Title:currently there are no job openings at this department

Finance

Title:Project Manager, Strategic Planning
Dept:   Finance
Grade:   9
Shift:   Monday – Friday
Location:  Adams St
Date Posted:  8/13/10

Job Summary:
Provide critical support to the development, execution and monitoring of the organization’s strategic plan, goals and major performance improvement projects and initiatives.

Principal Duties and Responsibilities:
The duties and responsibilities of the Strategic Planning Team involve facilitation of and support for the continuous process of planning, execution and monitoring. The Manager will perform these duties and responsibilities as part of their own direct-to-customer deliverables and as support for other team member deliverables. The audience of the work will vary, but will often include direct support for and deliverables to Senior Staff.

Duties and responsibilities are interrelated. Percentages shown are for percent of time spent on the respective duty.

1.) Strategic planning (35%): Play lead and key support roles in both substantive and administrative aspects of the strategic planning process.

Substantive: Translate complex business needs, issues and internal and external conditions into long- and short-term strategic planning for the organization. Facilitate the organization in deliberating/deciding on the long-term strategic plan and the shorter-term goals and projects/initiatives that effectively align individual and organizational resources to pursue the plan. Collect, compile and synthesize internal and external data and draw insights, inferences and implications to inform and influence planning decisions. Develop and maintain materials that communicate short- and long-term planning decisions to varied audiences, ranging from the Board-level to Management.

Administrative: Scheduling and logistics, as well as content-driven aspects (e.g., meeting agendas, presentations), of the strategic planning process. Assist in the planning and execution of all steps in the process, including but not limited to goal-setting/review meetings, the annual
Leadership planning offsite (as well as preparatory and follow-up activities) and quarterly Management Team gatherings.

As it relates to execution of the organization’s plan, the Team’s work will include both substantive and administrative support (i.e., though and action leadership) for major cross-organizational initiatives and steering committee efforts.

2.) Support for execution and performance monitoring (35%): Support the execution of short- and long-term plans with value-added data, analysis, market research and business intelligence. Identify, analyze, monitor and communicate on issues that effect profitability, growth and operational performance.

Dashboards: Become an owner of the conceptualization, design, development, production and use of metrics and corporate performance dashboards. Other analytical/reporting capabilities: Collect, compile and synthesize internal data and draw insights, inferences and implications of data/trends to inform and influence execution decisions and performance. Research and incorporate benchmarks and best practices.

3.) Strategic position and market analysis (15%): Collect, compile and synthesize external marketplace data into business intelligence about our strategic position (strengths, weaknesses opportunities and threats). Draw implications for strategy, execution and performance targets. Serve as subject matter expert on assigned industry/market topics.

For #1-3 above, incumbent will manage staff on project-by-project basis. This involves organizing, monitoring, directing and coaching/developing staff to deliver the highest quality and most timely deliverables.

4.) Staff management (10%): Manage staff on a direct basis. Monitor and coach/develop staff to support the personal and professional growth necessary to increase their value to the team and organization. Responsibilities will also include recruitment and hiring.

5.) Other duties and responsibilities (5%): Assigned as needed and may include basic administrative support.

Critical factors for success and growth:

Critical thinking and problem solving are essential and required skills. An aptitude for data/analysis is a necessary condition for success and must be a priority for learning and development.

There must a growing level of independence in conceptualizing, planning and executing projects of increasing complexity, value and organizational reach. To be successful, the incumbent must continuously advance their knowledge, understanding and application of the following: 

– (1) The business of Health Plus; (2) its operations and performance; (3) the competitive marketplace; and (4) the implications of these things for Health Plus strategy and execution.

– (1) Data sources and collection; (2) Data use and interpretation; (3) Database management, manipulation, and querying using Microsoft Access/Excel/SQL; (2) Statistical and other methods/tools for analyzing data; and (3) Compelling visual presentation of information.

Concepts and practices of strategic planning,
– Including dashboards and other metrics-based performance monitoring tools and techniques.

– Skills and practices of organizing and facilitating cross-organizational teams for group planning, problem solving and implementation.

The incumbent must effectively collaborate and cooperate with various levels of staff throughout the organization, including Senior Staff and Leadership. Build and leverage relationships up and across the organization to make the position and the team more effective and influential.

Work must be audience-appropriate, compelling and effective. Seek and incorporate customer feedback to improve these and other aspects of work quality.

Success involves effective management and leadership of staff, as evidenced by: (1) progress of individual staff performance against their development plan, (2) quality and quantity of team work production, and (3) staff and team satisfaction.

Attendance at local and national industry conferences and events will be required. Engagement of various other materials and resources is also necessary to become a “go to” resource on assigned subject matter.

A wide (and increasing) degree of creativity and latitude is required. Though work will be done under general supervision, immersion, independence and initiative are key determinants and measures of quality performance.

As with all Strategic Planning team members, work will involve the successful completion of administrative tasks such as meeting arrangements, record keeping, filing, copying, etc.

 Required Education and Experience:
BA and 6-8 years relevant experience; relevant Masters (preferred) and 3-5 years relevant experience

Title:Contracting Specialist
Dept:   Finance
Grade:   8
Shift:   Monday – Friday
Location:  Adams St
Date Posted:  6/18/10

Job Summary:
Under the overall direction of the Associate Director –Contracting, the Contract Specialist:
• Provides expertise to the development of Hospital and Ancillary contracts
• Negotiates with Providers and is responsible for tracking the status of contracts during the negotiation process
• Develops analytical summaries of upcoming contracts
• Has Project Management duties of contracting initiatives

Principal Duties and Responsibilities:
• Assists Associate Director in effectively negotiating contracts
• Prepares financial analysis and makes recommendations of reimbursement proposals for new and existing contracts based on data analysis
• Prepares analysis/interpretation and makes recommendations on language requests when negotiating or renegotiating contracts
• Upon finalization of negotiations, prepares final contracts for provider signature, draft amendments to contracts and conducts follow-up and tracking as needed
• Coordinates the implementation process of new contracts with the Provider Relations, ITS and Claims departments
• Investigates and resolves provider contracting inquiries and complaints
• Investigates and resolves intra and interdepartmental contracting inquiries
• Maintains financial grid of hospital rates and business terms that are not the standard for Health Plus (includes tracking trend increases)
• Coordinates quarterly meeting with each area of Provider Relations
• Monitors Ancillary network growth and recruitment needs
• Other activities and duties as assigned by the Associate Director

Job Specifications:
• Working knowledge of managed care concepts and health care delivery
• Knowledge of facility and/or ancillary contracts, specifically managed care contracting language and reimbursement methodologies e.g. DRGs, APGs, APCs
• Must be detail-oriented
• Must have excellent interpersonal skills and be able to work with people at all levels within and outside the organization
• Must have strong analytical and writing skills Must know word processing, must have good spreadsheet application skills. Experience with rate modeling, database management programs and/or MedStat

 Required Education and Experience:
•  B.A. or B.S. degree, Masters degree preferred, health related field preferable
• Five years experience in health care delivery or managed care with at least two years contracts experience

Title:Administrative Associate
Dept:  Finance
Shift:  Monday – Friday 9:00am – 5:00pm
Grade:  3
Date Posted: 8/06/10

Job Summary:
Provides administrative and secretarial support for the Chief Financial Officer and backup support to the entire Executive Team. In addition to typing, filing and scheduling, this position performs duties such as financial record keeping, coordination of meetings and conferences, obtaining supplies, coordinating direct mailings and working on special projects. Also, assembles highly confidential and sensitive information.  Deals with the diverse group of important external callers and visitors as well as internal contacts at all levels of the organization. Independent judgment is required to plan, prioritize, and organize diversified workload, recommends changes in office practices or procedures.  Must be detail oriented, a self starter, use his/her time efficiently and able to prioritize and multi-task.

Principal Duties and Responsibilities:  *Essential Functions
• Schedules and organizes complex activities such as meetings, travel, conferences and department activities for all members of the department.
• Performs desktop publishing; creates and develops visual presentations.
• Establishes, develops, maintains and updates filing system for the CFO and the department. Retrieves information from files when needed. Establishes, develops, maintains and updates library of trade journals and magazines.
• Uses Excel to track and monitor contracts and other material.  Retrieves information from files when needed.
• Organizes and prioritizes large volumes of information and calls. Sorts and distributes mail. Takes messages or fields/answers to all routine and non-routine questions.
• Acts as a liaison with other departments and outside agencies, including high-level staff such as CEO’s, Presidents, Vice Presidents and Chiefs. Handles confidential and non-routine information.
• Works independently and within a team on special nonrecurring and ongoing projects. Acts as project manager for special projects, which may include: planning and coordinating multiple presentations, disseminating information, coordinating direct mailings, creating brochures, working on Board material for internal or external organizations.
• Types and designs general correspondence, memos, charts, tables, graphs, business plans, etc. Proofreads copy for spelling, grammar, and layout, making appropriate changes. Responsible for accuracy and clarity of final copy.

Required Skills:
o Extensive knowledge of business and an excellent command of the English language
o Knowledge of a variety of computer software applications in word processing, spreadsheets, database and presentation software
o Must have high level of interpersonal skills to handle sensitive and confidential situations. Position continually requires demonstrated poise, tact and diplomacy
o Some analytical ability is required in order to gather and summarize data for reports, find solutions to various administrative problems, and prioritize work
o Continual attention to detail in composing, typing and proofreading materials, establishing priorities and meeting deadlines

Required Education and Experience:
• Minimum 2 - 3 year of secretarial experience in a financial setting, office administrative procedures and use and operation of standard office equipment experience
• High School diploma or GED required.  Some formal secretarial train a plus

Health Education & Community Outreach

Title:currently there are no job openings at this department

Health Services

Human Resources / Training

ITS

Title:Business Analyst
Dept:  ITS/Applications Development
Grade:   8
Shift:   Monday – Friday days
Location:  37th St
Date reposted:  3/5/10

Job Summary:
The Business Analyst 1 will work within the Application Support Data Integration (ASDI) as a senior  team member and must be able to assist with complex configuration issues, including but not limited to new payment methodologies, contractual changes and fee schedule changes. Position will also be integral in the development of testing scenarios for all ASDI related projects including new functionality, fix application, system upgrades, new applications.  Performs a variety of complex administrative and technical work in ensuring the consistent flow of data to end users is accurate and available.
This position will also work closely with any departments that use all Health Plus enterprise applications

Specific Duties and Responsibilities
Analyze and configure contract, fee schedule, and rate change requests
Manage change control requests through Track-It
Create Ad-Hoc reports for other HP departments
Coordinate User Testing with different HP departments
Create detailed documentation (change control) for all projects
Act as the conduit between ITS and the user departments.
Assists in the review of processes and ways to improve them.
Participate in the testing for upgrades and fix cycles, new functionality, new systems
Act as subject matter expert in relation to all enterprise systems
Perform additional duties as assigned by the Manager– Application Support Data Integration
Work closely with the QA staff to ensure testing and the installation of all projects within the department are properly executed
Develop in depth training materials for use within the department for new staff
Create documentation/processing guides as assigned by the  Manager

Required Skills
ability to work independently with minimal supervision
Demonstrated proficiency in Microsoft Access/SQL or proven ability to learn appropriate software
Knowledge of relational database structure
Knowledge of standard industry terminology and coding [i.e. CPT. HCPCS, UB-94, ICD9] systems.
Strong interpersonal, communication, and presentation skills.
Ability to establish appropriate priorities, multi-task and responds appropriately to unplanned events
Excellent documentation skills (technical writing experience preferred).
Good analytical skills and ability to prioritize diverse responsibilities.
Effective problem solving and analytical skills are required with the ability to evaluate demands on time and resources effectively
Ability to work with all resource levels within the organization
Knowledge of system applications, preferably healthcare processing systems

Required Education and Experience
• BA/BS preferred or equivalent.
• Excellent written and verbal communication skills
• Prior managed care experience helpful but not necessary.
• At least 5 - 7 years experience in a similar position
• Experience with TriZetto’s Facets application preferred

Marketing / Medicaid

Title:Marketing Representative (4)
Department:  Marketing-Medicaid
Grade:   3
Location:  Queens South (1)
Language:  Bilingual –English and second language to be determined by Dept  

Location: Bronx (2)
Language: Bilingual –English and second language to be determined by Dept 

Location: Brooklyn North (1)
Language: Bilingual-English and second language to be determined by Dept  
 
Shift: Variable days and variable hours.  You will need to be available to work some weekend and holidays.
Date Posted:   8/6/10

Job Summary:
The Marketing Representative is responsible for identifying, educating, and enrolling qualified individuals and families into the three managed care plans operated by Health Plus: Child Health Plus, Health Family Health Plus, and Care Plus.  During the first six months of employment, the
Marketing Representative will be in a training program.  The Marketing Manager and Supervisor will provide regular feedback and evaluation on his/her performance. 
Principal Duties and Responsibilities:  *Essential Functions
*Markets Child Health Plus, Health Care Plus and Family Health Plus programs to prospective Members, which may be done on a one-on-one or group basis.
*Understands the overall requirements for Medicaid eligibility, Health Care Plus eligibility and Child Health Plus eligibility.
*Responsible for assuring those applications are accurately completed and that individuals are actually eligible to be enrolled in the respective programs.
*Helps the Marketing Manager and Supervisor identify potential new markets in the community.
Works cooperatively with other Marketing staff.   Meets overall team efforts.
*Makes marketing presentations to community organizations, local businesses, pharmacies and providers to inform their staff and clientele about programs and enrollment process.
Identifies special events that will assist the Marketing Department in promoting managed care in general and/or the Child Health Plus, Health Care Plus and Family Health Plus programs.
*Representatives must conduct enrollment activities.
*Works closely with Member Services and the Call Center to close all leads.
Responsible for maintaining appropriate records, including activity reports, expense reports.
Other duties as assigned by the Director of Marketing and Business Development, Assistant Director of Marketing and Business Development, the Marketing Manager or Supervisor.

Required Skills:
• Excellent organizations skills.
• Good oral communication skills.
• Must be self-motivated.
• Must be willing and able to work in a multi-cultural and multi-ethnic work environment.
• Must present an appropriate appearance and demeanor consistent with representing Health Plus in the community.

Required Education and Experience:
• High School diploma or G.E.D required.
• Health care and some marketing, sales and/or customer services experience preferred.
• Second language skills, if needed, to be determined by department
• Clean, valid NYS driver license a car is a plus.

Marketing / Medicare

Title:Medicare Marketing Representative (Multiple Positions)
Dept:    Marketing Department-Medicare
Shift:   Variable Days/Schedule
Location:  All Boroughs
Date Posted:  8/6/10

Job Summary:
The Medicare Marketing Representative is responsible for identifying, educating, and enrolling qualified individuals into the Medicare managed care plan operated by Health Plus. During the first six months in the position, the Medicare Marketing Representative will be in a training and performance evaluation period.  The Medicare Sales Manager will provide regular feedback and evaluation on his/her performance. 
• Internal Applicants will be sponsored for Certification/Health Insurance Licensing. 
New York State Health Insurance License is required prior to starting in position. 
• External Applicants must have a current Certification/Health Insurance License.

Principal Duties and Responsibilities:  *Essential Functions
• *Markets Health Plus Elite Medicare to prospective Members, which may be done on a one-on-one or group basis.
• *Understands the overall requirements for Medicare eligibility.
• *Responsible for assuring those applications are accurately completed and that     individuals are actually eligible to be enrolled in the program.
• *Helps the Medicare Sales Manager identify potential new markets in the community.
• *Works cooperatively with other Medicare Marketing staff.   Meets overall team efforts.
• *Makes marketing presentations to community organizations, local businesses, pharmacies and providers to inform their staff and clientele about programs and enrollment process.
• *Representatives must conduct enrollment activities.
• *Works closely with Member Services and the Call Center to close all leads.
• Responsible for maintaining appropriate records, including activity reports, expense reports.
• Other duties as assigned by the Medicare Marketing Sales Management.

Job Specification:
• Excellent organization skills.
• Good oral communication skills.
• Must be self-motivated.
• Must be willing and able to work in a multi-cultural and multi-ethnic work environment.
• Must present an appropriate appearance and demeanor consistent with representing Health Plus in the community.
• Able to work flexible hours (shifts, weekends etc.) as needed

Required Education and Experience:
• Successful track record in Field Marketing is required.
• Valid NYS Driver’s License and car are preferred.
• Bi-lingual skills preferred.  Second language to be determined by the department.
• NY State Health Insurance License is required.

Marketing / Business Development

Title:currently there are no job openings at this department

Marketing / Communications

Title:currently there are no job openings at this department

Marketing / Community Relations

Title:currently there are no job openings at this department

Marketing / Recertification

Title:currently there are no job openings at this department

Marketing / Retention / Recertification

Title:Supervisor
Dept: Retention
Grade: 7
Shift:  Monday – Friday may require some evenings & weekend hours
Location:  37th Street
Date Posted: 8/20/10

Job Summary:
The Retention Supervisor is responsible for recruiting, training, assigning, directing, motivating, and evaluating Retention Representatives.  The Retention Supervisor coordinates the work of the Retention Representatives with other retention functions

Principal Duties and Responsibilities:  *Essential Functions

• Assists in recruiting, hiring, and training Retention Representatives
• Supervises and directs Retention Representatives to ensure their success in targeting and retaining existing members
• Works closely with the Retention Supervisors to identify and develop retention opportunities.
• Establishes and meets annual retention projections.
• Works closely with Enrollment to identify and resolve issues associated with retention practices.
• Performs other duties as assigned from time to time by the Retention Manager.

Job Specification:

• Capable of training and motivating a multiethnic marketing staff.
• Good oral and written presentation skills

Required Education and Experience:

• Bachelor’s degree; appropriate experience may substitute for education requirement.
• Three years experience in retention, sales or marketing preferably in the field of Managed care or other health services.
• Two years supervisory experience.

Marketing / Special Events

Title:COV Driver
Dept:  Special Events
Grade:  3
Shift: Variable days and variable hours.  You will need to be available to work some weekend and holidays.
Location: Variable
Date Posted: 8/06/10

Job Summary:
Under the direct supervision of Special Events Manager and Supervisor, the COV Operator is responsible for the general maintenance and upkeep of the assigned vehicle, obtaining assigned schedule of events and ensuring the safe delivery of the vehicle to each assigned location.  The COV Operator works closely with the Special Events coordinator and Marketing Representatives by assisting with each assigned marketing event.

Principal Duties and Responsibilities:  *Essential Functions
Understands and obeys all city traffic ordinances and laws.
Obtains weekly schedule and maintain a detailed log with information regarding vehicle maintenance and event outcome.
Inspects vehicle on a daily basis, ensure that vehicles are made safe during their assigned schedule, and submit a detailed report when they become involved in a traffic accident.
Regularly maintains assigned vehicles, which will include mechanical, cleanliness, supplies, inventory, and update vehicle with latest marketing materials.
Assists the marketing staff in the distribution of literature at sites and special events; assist with general marketing activity as required.
Follows interdepartmental dress code guidelines and adhere to all company policies and procedures.
Manages their cash allotment for supplies and submit receipts.
Manages their time, plans for alternate routes, and consider weather conditions when driving to a site/event.
Follows instructions as prescribed.
Performs other duties as assigned.

Job Specification:
• Must be able to carry out assignments independently.
• Ability to handle fast pace, team oriented environment.
• Must be physically able to handle heavy lifting (packages, equipment and all event related supplies).
• Flexible work schedule, including weekends and holidays.
• Acts to solve problems and uses available resources to come up with alternative solutions.
• Bilingual preferred.

Required Education and Experience:
• Minimum one to two years experience in marketing, special events or related experience.
• Experience in health care setting preferred.
• High School diploma or equivalent.
 Clean, valid New York State Driver’s License required

Medical Director’s Office

Title:Project Manager of Special Needs

Title:   Project Manager, SNP Model of Care
Dept:   Health Services
Grade:   9
Shift:   Monday – Friday
Location:  Adams St
Date Posted:  7/30/10
Job Summary:
The Project Manager will provide oversight of all care coordination, monitoring and contract oversight activities related to the SNP Model of Care.

Principal Duties and Responsibilities:  *Essential Functions
• Principal liaison to Health Integrated for Model of Care Contract     
• Holds weekly meetings to review implementation of MOC contract, including health risk assessments, care plans, care coordination and overall quality assessment
• Participates in care plan reviews
• Maintains database for all member care plans and monitors with Health Integrated individual and collective performance on care plan completion.
• Works with the Health Services staff to arrange for needed services for SNP and HP elite members.
• Monitors and reports on implementation of SNP contract to Health Services leadership
• Collaborates with member and provider services to orient members and network on MOC requirements and goals for the program
• Works with provider services and Health Integrated to promote physician participation in care plan development and implementation.
• Works with Health Services staff to provide additional DM services to high risk members
• Assists in preparation of reports to CMS on performance of SNP, including quality of care, costs, and other measures required by CMS
• Understands the requirements for Medicare and SNP eligibility, marketing plans, and growth targets
• Will review requirements for NCQA certification of SNP plans and prepare, if necessary, a plan to obtain certification
• Works within the department and with other departments to improve processes in which the Health Services unit is involved.
• Performs other duties as assigned by the Medical Director

Job Specification:
• Experience with implementation of disease management, member services, or health education programs is strongly preferred.
• Proven ability to independently, effectively and efficiently develop and implement problem solutions.
• Successful track record in effectively managing and motivating other professional and paraprofessional staff.
• Must be a team player, highly organized, and able to handle multiple tasks simultaneously.

Required Education and Experience:
• Bachelor's Degree in Healthcare Administration or related field required.
• Master’s Degree in Business, Public Administration, Health Administration, Nursing or other health related field is strongly preferred.
• 3 years of experience in managed care or health related field.
• 2 years supervisory experience in a managed care environment is preferred.

Medical Management Call Center

Title:Health Services Representative
Dept:   Medical Management Call Center
Grade:   3
Location:  Adams St.
Shift:   Days Monday – Friday
Date Posted:  8/13/10

Job Summary:
The HS Representative is responsible for servicing the Health Services call center, processing requests for medical services, assisting providers in locating in-plan providers, and working in partnership with the clinical staff to coordinate services for Health Plus members within the appropriate network of care.

Principal Duties and Responsibilities:  *Essential Functions
• Responsible for servicing a physician call center, consisting of incoming and outing calls and faxes from physicians, hospitals and other health care providers requesting approval for health care services. 
• Processes complex requests for medical services, including
1) verifying eligibility;
2) obtaining initial medical information and performing some basic analysis such as determining if the request for specialist matches the diagnosis given and
3) entering the demographic and medical information in the computer system. 
4) Responsible for complete data entry in computer requiring knowledge of medical terminology and basic coding terminology.
• Based upon health plan policy and where applicable;
 makes a determination based upon the medical information given and issues an approval by calling or faxing a response to the provider or;
 refers the case to clinical staff (registered nurses or social workers) as appropriate for further review. 
• As part of the authorization process, when a request is made for out-of-network services, redirect members and physicians to participating providers and facilitate the access to services to prevent delays in treatment.
• Enters new cases for Disease Management Program in the computer system and refers them to the registered nurse for review. 
• Sends the Disease Management questionnaire and Health Education literature to the member.
• Administers the Asthma Health Risk Assessment over the phone and documents this in the computer if the member calls in; documents the result of the Disease Management Questionnaires returned in the mail in the DM section of the Facets computer system.

Required Education and Experience:
• High School Diploma or GED required
• At least two years experience working in health care required; preferably managed care or HMO setting
• Must be willing and able to work flexible hours including evenings if required by the health plan
• Experience working directly with providers and patients is preferred

Title:Provider Services Representative
Dept:    Medical Management Call Center
Grade:   5
Shift:    Monday – Friday
Location:    Adams St
Date Posted: 8/6/10

Job Summary:
Under the overall direction of the Director for Network Management and Provider Relations and under the direct supervision of the Provider Relations Manager, the Provider Services Representative is responsible for insuring timely resolution of all provider inquiries.

Principal Duties and Responsibilities:  *Essential Functions
• First line response to all telephone, fax, or mail inquiries for providers and provider office staff
• Tracks all inquiries in Customer Focus
• Provides real time response to inquiries related to credentialing status, status of authorizations, status of submitted claims and member Eligibility
• Responds to requests for HEALTH PLUS provider materials (including Directories, Provider Manuals, Educational Materials, Forms)
• Provides initial intake and response to provider issues and complaints. In conjunction with Provider Relations Associates, investigates and resolves provider issues and complaints. The PSR is responsible for tracking and insuring timely resolution
• Responsible for identifying and tracking provider issues and referring frequent issues to Provider Relations Manager in order to address potential system changes
• Responsible for telephone surveys of Provider Offices
• Responsible for both oral and written correspondence with Providers
• Other activities and duties as assigned by the Provider Relations Manager

Required Skills:
• Must be able to work with people at all levels within and outside the organization and facilitate work group processes
• Must have excellent interpersonal skills and be able to work with providers and provider staff
• Must know Microsoft Word for Windows and must have good spreadsheet application skills. Experience with database management programs is a plus
• Must be willing to take classes in applicable HEALTH PLUS applications

Required Education and Experience:
• B.A. or B.S. degree or equivalent experience preferred.
• Experience in Provider Relations in a managed care organization preferred.

Member Operations

Title:currently there are no job openings at this department

Member Services

Title:Member Services Representative (1)
Dept:  Member Services
Grade:  3
Location: 37th St
Shift: Tuesday –Friday 12:00pm-8:00pm & Saturdays 9:00am– 5:00pm (Amended 7/30/10)
Language English/Russian
Date Posted:  1/29/10 

Job Summary:
The Member Service Representative is responsible for orienting HEALTH PLUS members on how to use the plan and provider network appropriately, addressing concerns, grievances and disenrollments expeditiously, assisting in the overall development and implementation of programs to increase member satisfaction.

Principal Duties and Responsibilities:  *Essential Functions
Serves as an advocate for HEALTH PLUS members within a managed care environment to ensure their satisfaction with the plan.     
Orients new members to HEALTH PLUS through telephone orientation sessions.
In coordination with the Patient Care Coordinators and Outreach staff, follows up with members who need additional education/orientation about how to use HEALTH PLUS services.
Maintains and tracks all member contact in Customer Focus and follows up on cases on a timely basis with appropriate departments.     
Understands the overall requirements for Medicaid eligibility, HEALTH CARE PLUS eligibility, and Child Health Plus eligibility.    
Maintains ongoing communication with provider network, participating pharmacies and government managed care representatives  
Responds to inquiries and member issues concerning Plan benefits on a timely basis  
Makes the necessary decision and effort to retain enrollees so as to achieve and maintain enrollment at projected levels.  
Meeting Call Center standards by answering calls within 20 sec keeping calls to a minimum of 2:00 minutes per calls and maintaining an average of 50-60 calls a day (including walk-ins).
Using proper telephone etiquettes when speaking to customers  
Maintaining attendance  
Punctuality
Performs other related duties as assigned or requested

Required Skills:
Must have good organizational skills.
Must be able to communicate effectively both orally and in writing in order to solve problems.
Must be self-motivated
Must type 25-30 wpm

Required Education and Experience:
High School Diploma or GED required.
At least one (1) year of customer service experience required.
Must be bilingual

Operations

Title:Project Manager
Dept:   Operations
Grade:  9
Location: 37th Street, Brooklyn, NY
Shift:  Monday – Friday, 9:00 am to 5:00 pm (ability to be flexible preferred)
Date Posted: 8/13/10  

Job Summary:
The Business Analyst 1 will work within the Operation Division as a senior team member and must be able to provide data support including, but not limited to: paid/denied claim trends by provider, by claim type, by reimbursement methodology, by aging as well as conduct ROI analyses based on reduction of authorization requirements. Other data support includes analysis of call center performance metrics to facilitate management's allocation of resources based on anticipated demand; root cause analysis of inbound member calls to be utilized as the basis for future process improvement initiatives. Further, to serve as the project manager in coordinating and evaluating critical strategic initiatives including but not limited to I-HT and FEEA.

Principal Duties and Responsibility:
1. Claims
• Analyze and develop baseline metrics —
• Denial rates by provider
• Denial reasons by provider
• Turnover rate, by claim type, by provider type of initially denied claims
• Develop tracking tool to identify all claims pended and sent out for departmental review
• Develop tracking tool on insure timely response to all claim appeals
2. Member Services
• Analyze and develop a demand model for inbound calls that facilitates assignment of staff resources to meet in-bound call demand
• Analyze and develop an Out-bound model that identifies peak success times and days to facilitate the improvement of outbound metrics
• Collect and analyze inbound call reasons to permit the development of actionable and measurable improvement initiatives
3. Other projects
• Coordinate logistics and manage overall I-HT project
i. Analyze results as well as future I-HT initiatives with respect to provider/member disruptions, ROI on new initiatives as well as tracking of inpatient validation efforts
• Coordinate logistics and manage overall FEEA project
• In conjunction with Ops and ITS Leadership, evaluate and revise when necessary, standard business (Business Objects) reports to insure applicability to current business needs
4. Perform data collection, data analysis and project management duties as assigned.
5. Work closely with the Ops leadership group to ensure understanding of all data collection and analysis initiatives

Required Skills:
• Ability to work independently with minimal supervision
• Demonstrated proficiency in Microsoft Access/SQL or proven ability to learn appropriate software
• Knowledge of relational database structure
• Knowledge of standard industry terminology and coding [i.e. CPT. HCPCS, UB-94, ICD9] systems.
• Strong interpersonal, communication, and presentation skills.
• Ability to establish appropriate priorities, multi-task and responds appropriately to unplanned events
• Excellent documentation skills
• Good analytical skills and ability to prioritize diverse responsibilities.
• Effective problem solving and analytical skills are required with the ability to evaluate demands on time and resources effectively
• Ability to work with all resource levels within the organization

Required Education and experience:
• BA/BS preferred or equivalent.
• Excellent written and verbal communication skills
• Prior managed care experience helpful but not necessary.
• At least 3 - 5 years experience in a similar position

Title:Receptionist (2)
Dept:   Operations
Grade:  2
Location: 37th Street
Shift:  Monday – Friday, 12:00pm to 8:00 pm (ability to be flexible preferred)
Language English & Spanish speaking
Date Posted: 7/23/10     

Location: Jamaica Ave 
Shift:  Monday – Friday, 12:00pm to 8:00 pm (ability to be flexible preferred)
Language English & Spanish speaking
Date Posted: 8/27/10 

Job Summary:
This position is responsible for courteously greeting visitors, clients, members, vendors and job applicants, determines their needs and directs them to the appropriate person and/or office.

Principal Duties and Responsibility:
• Answers telephones in a prompt and courteous manner.
•  Takes accurate messages and delivers them to the intended person in a prompt and timely manner.
• Receives packages and routes them to the appropriate person.
• Prepares car service vouchers and arranges for car services for authorized personnel.
• Maintains visitor/member log.
• Ensures that all visitors being escorted into HIPPA restricted areas have the proper ID Badge on.
• Provides assistance, guidance, and directions to visitors, members, vendors and job applicants.
• Notifies the appropriate supervisor/manager if the reception area is in need of cleaning or other services.
• Some duties and responsibilities will vary by location.

Required Skills and Experience:
• Excellent communication and interpersonal skills.
• Ability to work in a fast pace environment.
• Knowledge of Microsoft applications such as Word & Outlook.

Required Education:
• High School diploma or GED required
• Previous receptionist experience strongly preferred.

Title:Mailroom Driver
Dept:  Operations
Grade:  2
Location: 37th St
Shift:  Monday –Friday days
Date Posted: 7/23/10

Job Summary:
Under the general supervision of the Office Manager the Messenger/Driver works in conjunction with departments to assure that all company documents are delivered in a timely manner to the various sites.

Principal Duties and Responsibilities:  *Essential Functions
• Delivers mail, packages and other items between sites and departments in a timely manner
• Maintains service and maintenance log for vehicle.
• Responsible for scheduling and delivering van for routine maintenance.
• Reports necessary repairs to the assigned vehicle.
• Performs related duties as required.

Job Specification:
• Valid NYS Driver license is required
• Good communication skills

Required Education and Experience:
• High School Diploma or GED
• Previous messenger or driving experience preferred

Provider Relations

Title:Data Specialist
Dept: Provider Relations / Credentialing
Grade: 3
Shift: Monday – Friday days may requires some overtime which includes Saturday
Location:Adams St

Job Summary:
Under the overall direction of the Provider Relations Operations Manager and under the direct supervision of the Data Center Supervisor, the Data Specialist is responsible for the entry of all provider data on sophisticated systems in a multi-system environment.

Principal Duties and Responsibilities:  *Essential Functions

Job Specification:
o Must be able to work with people at all levels within the organization and facilitate work group processes
o Must have knowledge of product benefits, provider contracts
o Must know Microsoft Word for Windows and must have good spreadsheet application skills.
o Must be able to navigate in a multi-system environment
o Experience with database management programs is a plus|
o Detail Oriented

Required Education and Experience:

Title:Administrative Assistant
Department:   Provider Relations
Location:  Adams St
Grade:   3
Schedule:  Monday – Friday days some overtime may be required

Job Summary:
The Administrative Assistant provides general administrative support to the Vice President of the Provider Relations Department & management staff.. Duties include office support, clerical and project based work including maintaining reports and the Vice president’s calendar.

Principal Duties and Responsibilities:  *Essential Functions
Provides status reports to vice president and management team.
Performs general clerical duties to include but not limited to: photocopying, filing, faxing and mailing, answering phones, maintaining calendar etc. 
Creates and modifies documents using MS Word and Excel.
Maintains hard copy and electronic filing systems.
Assists the vice president and the medical director in preparing for upcoming events and coordinates events logs.
Prepares agendas & reports for weekly meeting between for the management team and the medical director.. 
Manages the vice president’s Organizer and calendar.
Sets up presentation packages as needed.
Assists with the preparation for the Articles 44 audit which may occur yearly.
Provide back up support for the other administrative assistants and the executive assistant as needed.
Other duties as assigned by the vice president.

Required Skills:
Strong organization skills and attention to detail.
Able to cope with deadlines and time sensitive reporting.
Effective communicator by phone and in-person.
Professional image and demeanor.
Team oriented, flexible attitude.

Education and Experience:
• High School diploma or equivalent (G.E.D.) required.
•  Two years of clerical and/or some professional office administrative experience is required.
• Solid working knowledge of Microsoft Office Suite, Outlook and Blackberry needed.

Title:Senior Data Analyst
Dept:  Provider Relations/Credentialing
Grade:  7
Shift:  Monday – Friday days
Location: Adams St
Date Posted: 8/6/10

Job Summary:
Under the overall direction of the Senior Manager of Provider Relations Operations, the Senior Data Analyst is responsible for providing and coordinating technical and operational supports to Provider Relations and Network Development Department.

Principal Duties and Responsibilities:  *Essential Functions
• Assists management in designing reports in monitoring network adequacy; ensures the timeliness and completeness of the reporting generation and distribution. They include:
o Network Assessment Map Report
o Provider Capacity Report
o Network Growth Report
• In conjunction with IT, and other Provider Relations areas, responsible for integrity of HEALTH PLUS Provider database and other provider listings (e.g. provider contact listings)
o On a monthly basis, develops and generates reports for areas to review the HEALTH PLUS Provider database for accuracy and completeness
• In conjunction with MIS and Credentialing, responsible for the Health Provider Network quarterly submission
• Responsible for the production of all HEALTH PLUS Provider Directories (printed version and online version, full version and language version)
• Oversees and supports GeoAccess Enterprise Directory System
• Acts as a liaison between IT and PR to develop the enterprise reporting application
• Designs and develops reports to support all reporting needs in PR areas
• Trains, coaches and develops new data analyst(s)
• Assists in developing and evaluating data analyst(s)
• Makes recommendations regarding hiring/termination
• Other activities and duties as assigned by the senior Manager of Provider Relations Operations and the Director of Network Management and Provider Relations.

Job Specification:
• Must be able to work with people at all levels within the organization and facilitate work group processes.
Must have excellent interpersonal skills and be able to work with providers and provider
• staff.
• Must have project management experience
• Must have excellent computer skills.  Mastery in Microsoft Excel and Access for Windows, and GeoAccess applications.  Experience in a page layout application and other database management programs is highly desirable.
• Must be willing to take classes in applicable HEALTH PLUS applications.

Required Education and Experience:
• Must be able to work with people at all levels within the organization and facilitate work group processes.
• Must have excellent interpersonal skills and be able to work with providers and provider staff.
• Must have project management experience
• Must have excellent computer skills.  Mastery in Microsoft Excel and Access for Windows, and GeoAccess applications.  Experience in a page layout application and other database management programs is highly desirable.
• Must be willing to take classes in applicable HEALTH PLUS applications.

Title:Quality Systems Auditor
Dept:  Provider relations
Grade:  8
Location:  Adams Street
Shift:  Monday – Friday days
Date Posted: 6/11/10

Job Summary:
Under the overall direction of the Director of Provider Relations Operations, the Auditor has overall responsibilities for auditing, facilitating continual process improvement, and training in the Provider Relations and Network Management department.  To ensure compliance with government guidelines and requirements, she/he will develop, implement and maintain a quality audit system. 

Essential Duties and Responsibilities:
• Develop, implement and maintain a current quality audit system
• Identify trends and areas in need of improvement; make suggestions on improving work process & procedures in Provider Relations & Network Management department.
• Confer with management, supervisors and employees to gain knowledge of work situations requiring training and to better understand changes in policies, procedures, regulations, business initiatives and technologies.
• Nurture strong relationship with all PR areas to identify training needs, develop training materials and courses
• Supervise and support Quality System Specialists (QSS) in auditing, training, and other system supports
• Train, coach and develop new and existing QSS
• Complete performance evaluations, and make recommendations regarding hiring and termination
• Work in conjunction with Manager, Provider Training to ensure policy and procedures in compliance with the NYS & NYC DOH’s requirements and guidelines.
• Other duties may be assigned to meet business needs.

Other Skills and Abilities:
• Ability to read and interpret documents such as technical data and policy and procedure manuals
• Ability to write routine reports and correspondence
• Ability to develop and write training materials
• Ability to speak effectively in interpersonal situations and before groups of employees
• Proven presentation and facilitation skills.
• Self-motivation.  Able to function independently, and set priorities effectively in a multi-task environment
• Able to interact with all levels of management and employees in a flexible, professional and tactful manner
• Strong analytical, planning, organizational skills.  Detail oriented.
• Demonstrated proficiency in Health Plus provider network, provider systems, contract implementations and Customer Focus.
• Must have knowledge of Microsoft Word, Excel, Access and Power Point.

Education and Experience:
• B.A. or B.S. Degree required, Master Degree preferred
• One year of supervisory experience preferred
• One year experience in managed care organization, preferably in provider relations

Quality Improvement

Title:currently there are no job openings at this department