| Behavioral Health
| Claims
| Community Relations
| Compliance
| Enrollment
| Executive Office
| Finance
| Health Education & Community Outreach
| Human Resources
| Health Services
| ITS
| Marketing/Medicaid
| Marketing/Medicare
| Marketing Business Development
| Marketing Communications
| Marketing Community Relations
| Marketing Recertification
| Marketing Retention
| Marketing/Special Events
| Medical Director’s Office
| Medical Management
| Member Operations
| Member Services
| Operations
| Provider Relations
| Provider Services
| Quality Improvement
| Regulatory Affairs
| Training
|
:Senior Behavioral Health Representative
Dept: Behavioral Health
Grade: 5
Location: Adams St
Shift: Monday – Friday days
Date Posted: 10/23/09
Job Summary:
The Senior BH Representative is responsible for assisting members in getting to their aftercare appointments after psychiatric confinements and for obtaining written confirmation from providers verifying their attendance.
Principal Duties and Responsibilities: *Essential Functions
• Works closely with Health Plus BH clinical staff , being updated on psychiatric admissions and discharges
• Works with external home care agencies keeping them informed of psychiatric admissions and discharges on a timely basis
• Tracking referrals to home care agencies
• Outgoing and incoming calls to and from members assisting them in getting to their aftercare appointments
• Outgoing and incoming calls to and from providers regarding written confirmations verifying members’ attendance at aftercare
• Sending letters to members and providers
• Tracking confirmations received
• Tracking incentives sent to members
• Entering notes in FACETS and Medecision regarding cases
• Collecting and distributing e-faxes
• Collecting and distributing mail
• Printing out authorization letters from FACETS
Required Skills and Experience:
• 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
• Must have good customer relations skills and be able to communicate effectively with members, providers and other Health Plus staff.
• Bilingual preferred – second language to be determined by department
• Must be highly organized and be able to perform multiple tasks simultaneously.
• Must be able to work autonomously and require minimal direct supervision
• Must be able to communicate effectively orally and in writing in order communicate the outcome of problem solving efforts
• Must have experience with Excel and Word
Required Education:
• High School Diploma or GED required
:Managed Care Clerk
Dept: Behavioral Health
Grade: 2
Location: Adams St
Shift: Monday – Friday days
Date Posted: 12/8/09
Job Summary:
The Managed Care Clerk provides clerical support to the Behavioral Health Department for the for the coordination of all administrative paperwork.
Principal Duties and Responsibilities: *Essential Functions
Maintains a tracking system for member eligibility issues and coordinates with Member Services on these issues.
Supports the Behavioral Health department clerically by handling correspondence, specific correspondence for a variety of focused issues, takes messages, schedules meeting, handles photocopying and filing.
• Establishes and maintains good working relationships with other departments in Health Plus in the course of problem.
Maintains staff productivity and other statistics for the Manager.
Generates and tracks ACD phone statistics.
Performs other duties as assigned.
Job Specification:
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 be able to handle multiple tasks simultaneously and require little supervision.
Some computer skills preferred
Required Education and Experience:
• High School Diploma or GED required.
• At least one year of customer service/data entry experience required; health care customer relations preferred.
:Senior Claims Analyst (3)
Dept: Claims
Grade: 5
Shift: Monday – Friday 9:00am – 5:00pm
Location: 37th St
Date Posted: 12/11/09
Basic Function:
The Sr. Claims Analyst is responsible for the complex areas of the claims adjudication process. He / she will perform these duties using all documentation available to the claims department as well as communications with Health Services, the Medical Director’s office and other areas of Health Plus management. He/she assists the supervisor advising claims processors and claims analyst in claim adjudication issues as well as post adjudication payment authorization.
Required Specific Duties and Responsibilities
• Reviews inquiries from various Health Plus Management disciplines, readjudicates claims where necessary.
• Assists supervisor in training new candidates for Sr. Claims Analyst
•Answers questions presented by claim staff regarding any claims issues
• Interprets medical policy when necessary
• Questions health services on unique claim situations requiring clarification of authorization
• Interfaces with the Medical Director in review of unique claim circumstances
• Handles referred telephone inquiries including irate calls, and those referred by claims analysts
•Performs special studies and handles special projects at the request of the Supervisor, Manager or Director of Claims Administration
• In the absences of the supervisor monitors and controls unit workflow
• Handles complicated / complex claims based on analysis of medical and claim policy, medical authorizations, detailed medical notes in the Health Services system, as well as discussions with relevant Health Plus Management
• Identifies and reviews potential system problems and deficiencies and brings it to the attention of the supervisor and the Quality Specialists Identifies need for system modifications
-Interfaces with:
1. Provider Relations
2. Member Services
3. ITS
4. Model Office
5. Finance
6. Outreach
7. Health Services
Analyzes system suspense reports on electronic media claims, adjudicating claims or developing for additional information
• Interprets complex provider contracts as identified by Director of Claims Administration and processes claims associated with these contracts
•Maintains claims inventory and accuracy statistics for the area and reports same to supervisor
Knowledge and Skills:
Ability to work independently
Must work well with people
Must be able to interact with providers in a professional manner.
Excellent verbal, written, and presentational skills
Must have knowledge of medical terminology, CPT and ICD.9 and DSM codes
Must have excellent mathematic skills to maintain and monitor batch controls and calculate payments and prepare statistical data
Knowledge of computers, electronic data interfaces, Excel, Word, Customer Focus
Must be meticulous and pay attention to detail
Required Education
Some college, Associates degree preferred, or 1-2 yrs. experience in Claims
Work Experience:
Prior Medical Claims processing (preferably in a Facets environment)
Prior Customer Service experience helpful
:Claims Manager
Dept: Claims
Grade: 9
Shift: Monday – Friday 9:00am – 5:00pm
Location: 37th St
Date Posted: Repost 11/20/09
Basic Function
Under the general direction of the Director of Claims Administration, the Claims Manager has the overall responsibility for the daily activities of the Claims Processing Unit. This includes responsibility for the receipt and processing of claims, Re-adjudications and Appeals. The Claims Manager supervises a staff including the Claims Supervisors, Quality Specialist I, and the Claims Correspondent. This position works closely with ITS, Provider Relations, Health Services, Outreach and Finance.
Specific Functions:
Manages staff in the Claims , Claims Prep & Front End Adjudication and Quality Specialists units
Coaches and trains the management staff of those units
Assures that the Claims Department staff follows Polices and Procedures
Oversees the establishment of new Polices and Procedures
Monitors claims staff productivity
Answers questions and assists claims staff in the daily functions of the area
Hires staff, performs annual performance reviews, enforces corporate polices and procedures through discussion and written memos maintains a file on each subordinate Holds monthly staff meetings
Investigates unique claim situations requiring policy clarification or other pending item resolution prior to claim adjudication
Analyzes claims referred to the Manager level of review
Generates weekly/ monthly status reports for the Claims Director
Monitors monthly productivity report
Monitors the monthly employee productivity report
Reviews provider contracts providing feedback to Senior Management
Interacts with the ITS department regarding systems problems
Reviews new system software with regard to implementation
Supports ITS effects in testing to implementation system upgrades and new systems
Responsible for understanding State Medicaid and CHP & FHP benefit criteria
Handles provider telephone inquires referred to the Manager level of review
Works with Finance Director to review payments issued to providers and facilities
Complies with yearly State Audits
Handles special request from the CEO for executive claim handling
Analyzes electronic data submissions for referring providers
Works closely with Provider Relations management to handle special requests or assist in training of new providers or facilities
Discusses unique claim situations with Medical Director to clarify policy and unique applications such?
Notifies Provider Relations of Policy or system changes that require dissemination to providers
Interacts with Outreach manager’s department regarding unique newborn claims
Interacts with PDI regarding imaging of claims
Interacts with Member Services manager on claim problems brought in by members
Annually works with the Director of Claims to create a Budget for the Claims Department
Required Knowledge and Skills
• Must be familiar with Medicaid and Medicare benefits
• Must have a thorough understanding of HCPCS, CPT, ICD-9CM and DSM coding systems
• Maintains a professional rapport with support staff and upper management
• Must have the ability to communicate clearly with a wide range of individuals, including physicians, providers, Health Plus members and Health Plus staff
• Must able to exercise independent judgment
• Must have managerial skills sufficient to supervise a claims operation including but not limited to: planning, organizing, procedural zing, implementing, following up, following through and analyzing results
• Excellent verbal and written communications skills
• Ability to comply with changing regulations and work flow environments at Health Plus
• Strong working knowledge of computers, electronic data interfaces, Excel and Word, Access
• Work under general guidance of Claims Director with little or no direct supervision
Required Skills
1. Two or more years of experience in Managed Health Care claims processing preferred
2. Knowledge of Polices and Procedures
3. Knowledge of Department of Health State rules and regulations
Required Education
Successful candidate should have either a Bachelor’s degree or Associates degree with equivalent years work experience.
Work Experience
At least five years of experience in Health insurance claims processing with at least two years of supervisory experience
Physical Demands
1. Work requires acceptably corrected visual acuity in order to frequently read a variety of materials
2. Continuous verbal communication using telephone and face-to-face.
3. Primarily sedentary
4. Ability to key on computer terminal to input and access informati0n
:Claims Correspondent
Dept: Claims
Grade: 5
Shift: Monday – Friday 9:00am – 5:00pm
Location: 37th St
Date Posted: 11/6/09
Basic Function:
Under the general supervision of the Claims Manager the Claims Correspondent has overall responsibility for the receipt and processing claims correspondence. The Claims Correspondent is responsible for Appeals requests, readjudications, and adjustments due to system errors. The Correspondent will be assigned all incoming telephone inquiries to the Claims Department. This position works closely with the Claims Manager, Medical staff, Management Information staff and the Finance staff.
Specific Duties and Responsibilities
• Review member complaints
• Review all Appeals request in preparation for discussion with the Director of Operations
• Readjudications of all appeals resulting in additional payments
• Written replies on all requests for appeals that are denied
• Review of hospital claims regarding erroneous denials
• Review of all outgoing letters initiated in the Claims Department
• Working with MIS to determine if processing errors can be corrected and erroneous payment adjusted internally
• Creating manual adjustments for those errors that cannot be corrected by the system
• Handling of all incoming telephone inquiries to the Claims Department (during peak volume periods overflow will be assigned to specific claims processors)
• Handling all callbacks required from incoming calls whether they were originally handled by the Correspondent or a Claims Processor
• Establishes policies and procedures for handling provider inquiries, complaints and appeals related to claim processing and insures claims and correspondence management implements these procedures
• Refers to Manager those provider and member inquiries, which cannot be resolved at other levels in the division
• Works with Claims manager investigating unique claim situations requiring policy clarification or other pending item resolution prior to claim adjudication
• Provides feedback to Claims Manager on situations resulting in erroneous claims dispositions
Required Knowledge and Skills
• Prior understanding of Health Insurance claims adjudication.
• Prior Knowledge of HCPCS<CPT< and ICD_9-CM coding systems.
• At least 3 years health insurance Claims Processing experience
• Must be familiar with Medicaid and CHP benefit criteria
• Must be familiar with HCP and CHP contracts
• Excellent communication skills and ability to work with all levels of Health Plus
• Solid analytical ability.
Required Education
High school graduate
College preferred
Skills:
• Work requires acceptably corrected visual acuity in order to frequently read a variety of materials
• Continuous verbal and communication using telephone and face-to-face
• Primarily sedentary
• Ability to key on computer terminal to input and access information
:Claims Analyst (1)
Dept: Claims
Grade: 4
Shift: Monday – Friday 9:00am – 5:00pm
Location: 37th St
Date Posted: 10/02/09
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
Job Summary:
Analyze and adjudicate pended claims generated from Rubi Reporting System
Research Health Plus member files when a discrepancy exists or eligibility is questioned.
Analyzes claims to determine appropriate reimbursement for par and non-par providers.
Analyzes claims by type of service interpreting Medical and Claim Policy and Procedures
Reviews provider refunds and applies adjustment workflows
Responsible for the adjudication of complex claims for various types of service
Refers claims with security restrictions and/or high dollar allowable to Senior Claims Analysts
Interacts with providers on the telephone or by correspondence, often dealing with Doctors, Medical Office Managers, Health Officials, Hospital Billing Management, and Billing Services
Determines NYS member eligibility using EMEV
Document and track claim inquiries using Customer Focus
Review correspondence to determine post payment accuracy
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
:Community Relations Associate
Department: Community Relations
Grade: 5
Shift: Variable
Language: English/Spanish preferred
Location: Brooklyn North
Date Posted: November 6, 2009
Job Summary:
Ability to effectively present information and respond to questions from Community Board Organization, (CBO’S) members and the general public.
Principal Duties and Responsibilities: *Essential Functions
• Promote community “goodwill” by participating in Conferences, Forums, Community Board, School Board, Police Council, Faith Groups and other Community Based Organization Meetings.
• Establish, maintain and develop relationships with all C.B.O.’s and coordinate presentations to educate C.B.O.’s about Health Plus in order to enhance the visibility of Health Plus in the community.
• Report all Community events and activities opportunities to the School Based Program Supervisor.
• Attend Community events and activities in order to enhance visibility and network for other opportunities
• Monitor distribution of informational supplies to all Community Based Organizations.
• Other duties as assigned.
Job Specification:
• Promote community “goodwill” by participating in Conferences, Forums, Community Board, School Board, Police Council, Faith Groups and other Community Based on Organization Meetings.
• Establish, maintain and develop relationships with all C.B.O.’s and coordinate presentations to educate C.B.O.’s about Health Plus in order to enhance the visibility of Health Plus in the community.
• Report all Community events and activities opportunities to the School Based Program Supervisor.
• Attend Community events and activities in order to enhance visibility and network for other opportunities
• Monitor distribution of informational supplies to all Community Based Organizations.
• Other duties as assigned.
Required Education and Experience:
Minimum one or two years of experience in marketing, sales, special events, fund-raising or other relevant experience.
Experience in health care setting preferred.
Associate degree preferred.
This position requires extensive travel throughout Brooklyn, Queens, Manhattan, Bronx and Staten Island; valid driver’s license and use of personal vehicle required.
Flexible work schedule, including weekends and holidays.
:currently there are no job openings at this department
:currently there are no job openings at this department
:currently there are no job openings at this department
:currently there are no job openings at this department
:Manage Care Clerk
Dept: Health Education & Outreach
Grade: 2
Shift: Monday – Friday 9:00am – 5:00pm
Location: 335 Adams Street
Date Posted: 10/23/09
Job Summary:
Provide administrative support to the Health Education and Community Outreach department; Health Educators; Prenatal Community Health Education Associates and Management staff. Ensure department staff has all the information, supplies and equipment necessary to perform their duties timely. Track member information in various Health Plus systems and departmental data systems.
Duties and Responsibilities:
Responsible to sort and distribute mail and accept packages daily
Responsible for maintaining and tracking inventory log of supplies for the Department
Data entry of Maximus and Care Planner (MeDecision)
Data entry for various management reports
Responsible for tracking Health Educator’s workshop attendance for management reports
Responsible for organizing new member orientation workshops
Responsible for Prenatal member mailings & data entry
Assist Prenatal Associate & Health Educators as needed
Scheduling transportation for staff as needed
Responsible for maintaining and tracking various office tasks; such as referrals and
mailings
In charge of creating, organizing and sending flyers to members for upcoming workshops
General office duties, faxing, filing and copying
Other duties as assigned
Required Skills and Experience:
Must have good computer skills; Microsoft office (outlook; word; excel; access)
Must have good organizational skills
Must be self-motivated
Must be able to work independently with little supervision
Must be able to handle multiple tasks
Must have good English oral & written communication skills
Required Education:
High School Diploma or Equivalency
Prior experience working in a professional environment preferred
:Prenatal Associate (2)
Dept: Health Education & Outreach
Grade: 5
Shift: Monday – Friday 9:00am – 5:00pm
Location: 335 Adams St
Date Posted: 10/23/09
Job Summary:
Under the overall direction of the HECO Operations Manager, the Prenatal Associate assists in identifying, and tracking all Health Plus prenatal members and newborns. Also, responsible for contacting prenatal members via phone or in person to provide education, conduct a health risk assessment survey, and inform members about Health Plus’ prenatal care program and services. The Prenatal Associate is responsible for processing enrollment of unborn and newborns through Human Resources Administration (HRA).
Duties and Responsibilities:
Identifies pregnant members through various sources and reports
Responsible for identifying potential high health risk newborns
Responsible for creating and maintaining records for each prenatal case
Educate prenatal member via phone, mail and live orientation sessions on the importance of
appropriate prenatal care, postpartum care, newborn care, and use of HP services (free
workshops, incentives, member services).
Complete health risks assessment surveys for prenatal member and newborn
Refers members to Health Services, Behavioral Health, Member Services, and Health
Education as appropriate
Mails educational materials to members timely
Responsible for enrollment of unborn and newborn through HRA
Responsible for communicating unborn and newborn information to Human Resources
Administration (HRA) as HRA protocol dictates
Creates a Health Plus ID number for the newborn after verification of the mother’s
ePACES for month of birth
Understands and utilizes systems that support prenatal process (i.e. ePACES, Facets,
Customer Focus, Access)
Responsible for making corrections to unborn and newborn cases with HRA
Performs other duties as assigned or requested
Required Skills and Experience:
Bilingual English-Spanish
Ability to communicate clearly with members and providers
Must have good oral and written communication skills in both languages
Must have familiarity with computers, especially ACCESS and database programs
Must have good organizational skills
Must be able to work independently with little supervision or as a team
Must be self-motivated
Must be able to handle multiple tasks simultaneously
Required Education:
High School Diploma or Equivalency required
Associate Degree preferred or equivalent experience
:currently there are no job openings at this department
:Appeal Analyst
Dept: Health Services
Grade: 4
Shift: Monday – Friday days
Location: Adams St
Job Summary:
This position is responsible for Administrative support to the Health Services Department and the coordination of all administrative paperwork.
Principal Duties and Responsibilities: *Essential Functions
• Maintains a tracking system for appeals status and coordinates with Claims Department on these issues.
• Tracks all timeframes and notifies the RN/Appeals Coordinator of upcoming timeframes or deadlines for appeals.
• Supports the RN/Appeals Coordinator clerically by handling denial and appeal correspondence, takes messages, schedule meetings, handles photocopying and filing.
• Provides clerical support to the Health Services Director by assembling and tracking monthly statistical reports
• Establishes and maintains good working relationships with other departments at Health Plus in the course of problem solving
• Responsible for maintaining the denial and appeals files in good order including weaning out outdated files, ensuring all files are complete with required information, etc.
• Speaks with providers and members to update them n status of the case and explain denial and appeal process as needed
• Assists the Managed Care Clerks with their duties as needed
• Performs other duties as assigned
Job Specification:
• Good problem solving skills
• Must work well with other staff members in collaborative manner and be a team player
• Good organizational skills and must be able to multi-task
• Must be able to complete all projects in a timely manner
• Good basic computer knowledge and willing to learn advanced skills.
• Must be excel literate
Required Education and Experience:
• High School diploma or GED
• At least one year of customer service experience required.
• Health care customer relations experience preferred.
:Administrative Assistant
Dept: ITS
Grade: 3
Location: 37th St
Shift: Monday – Friday days
Date Posted: 12/11/09
Job Summary:
Provides administrative and secretarial support for the CIO and ITS Department (including the Model Office). In addition to typing, filing, scheduling, performs duties such as financial record keeping, payroll, coordination of meetings and conferences, obtaining supplies, and all aspects of purchase order and invoice processing. Deals with a 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.
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.
• May perform desktop publishing; create and develop visual presentations for the Department
• *Establishes, develops, maintains and updates filing system for the CIO and the department. Retrieves information from files when needed. Organizes and prioritizes large volumes of information and distributes mail.
• Establishes, develops maintains and updates library of trade journals and magazines.
• Organizes and prioritizes large volumes of information and distributes mail. Takes messages of fields/answers all routine and non-routine questions.
• Works independently and within a team on special nonrecurring and ongoing projects. Acts as project manager for special projects, at the request of the CIO, which may include: planning and coordinating multiple presentations, disseminating information.
• *Types and designs general correspondence, memos, charts, tables, graphs, business plans, meeting notes etc. Proofreads copy for spelling, grammar, and layout, making appropriate changes. Responsible for accuracy and clarity of final copy
Job Specification:
• Extensive knowledge of business and an excellent command of the English language
• Knowledge of a variety of computer software applications in word processing, spreadsheets, database and presentation software
• Must have high level of interpersonal skills to handle sensitive and confidential situations. Position continually requires demonstrated poise, tact and diplomacy
• Some analytical ability is required in order to gather and summarize data for reports, find solutions to various administrative problems, and prioritize work
• Continual attention to detail in composing, typing and proofreading materials, establishing priorities and meeting deadlines.
Required Education and Experience:
• Minimum 2 year of secretarial, office administrative procedures and use and operation of standard office equipment experience.
• Formal secretarial education preferred.
:Business Analyst
Dept: ITS
Grade: 8
Location: 37th St
Shift: Monday – Friday days
Date Posted: 12/8/09
Job Summary:
The Business Analyst will perform a variety of complex technical and administrative tasks in ensuring that the ITS Development department is successfully communicating with business users. Responsibilities include implementing ITS Development business analysis practices and procedures outlined in a formal Software Development Life Cycle.
Essential Duties and Responsibilities:
• Oversee business analysis and requirements gathering for requested ITS Development tasks and projects.
• Assist in the creation, maintenance, and adherence to of various ITS Development standard documentation templates.
• Proof reading of various technical documents
• Participate in unit testing activities, evaluation, and validation of ITS Development software upgrades, bug fixes, and services.
• Analyze discrepancies in service or performance of computer software and make recommendations for product or service updates.
• Provide backup support for related positions as needed.
• Perform related duties as assigned.
Required Skills:
1. Excellent written and verbal communication skills.
2. Ability to work independently.
3. Detail oriented.
4. Good organization skills
5. Good all around information systems knowledge.
Required Education and Experience
1. BA/BS required
2. 2 years of Information Systems experience.
:Computer Operator
Dept: ITS
Grade: 5
Location: 37th St
Shift: Tuesday – Saturday 11:00PM – 7:00AM
Date Posted: 12/08/09
Job Summary:
Perform a variety of routine technical and administrative tasks in the accurate and timely processing of information in and through all computer systems. This includes the running of batch processes, running system utilities as needed, performing backups, running regularly scheduled processes and reports. The operator would be responsible for monitoring the performance of the system and responding to problems as needed.
Specific Duties and Responsibilities
• Document standard processes, update documentation as needed and create associated run sheets.
• Maintain a daily log of activities performed and completion of run sheets where appropriate.
• Runs batch processes and other regularly scheduled processes. Ensures the timely and accurate completion of these processes.
• Prints generated output and distribute output as needed.
• Retrieves files from and posts files to external bulletin boards as needed.
• Runs all backups and maintains tape library.
• Helps to maintain proper security of the computer room. Alerts management of any unsafe or potentially unsafe conditions in the computer room.
• May act as a Systems Administrator for the HP3000.
• May maintain the monthly MIS “schedule of events”.
• Provides backup support for related positions as needed.
• Perform related duties as assigned.
Required Skills
• Good verbal and written communication skills.
• Ability to work independently with little supervision.
• Working knowledge of computer hardware, peripherals and printers.
• Ability to adhere to strict schedules.
Required Education and Experience
• High School Diploma or GED required
• AA/AS, certificate program or equivalent desirable.
• At least 6 months computer operations experience. Prior experience in a banking environment desirable.
• Prior HP3000 experience highly desirable.
:Database Administrator
Dept: ITS
Grade: 9
Location: 37th St
Shift: Monday – Friday days
Job Summary:
The Database Administrator (DBA) performs a variety of complex administrative and technical work in managing the database and web applications of the enterprise, troubleshooting and system management. It is the DBA’s responsibility to ensure optimum performance of corporate databases and administer and support a variety of database and web applications
Specific Duties and Responsibilities:
• Perform application and database upgrades
• Support mission critical database and web applications ( 3rd party and internally developed )
• Performs production and test installations and maintenance work both during normal business hours and outside normal business hours as required.
• Works closely with other ITS staff including Application Development, Application Support and Data Integration, Operations and Quality Assurance
• Administers the database environments including configuration, security, resource monitoring and reporting, tuning and troubleshooting, backups and restore.
• Coordinates resolution of database and web application issues within the MIS department including applications and operations.
• Perform related duties as assigned.
Required Skills:
1. Excellent written and verbal communication skills.
2. Excellent working knowledge of database theory as well as hands on knowledge of industry standard databases (i.e. SQL Server, Sybase, Oracle, etc.)
3. Ability to work independently with little supervision.
4. Works well under pressure and possess good troubleshooting skills.
5. Must be extremely organized.
6. Healthcare application knowledge strongly preferred
7. Trizetto ( FACETS and PDM ) and IBM WebSphere experience preferred
Required Education and Experience:
1. BA/BS. MA/MS preferred.
2. Minimum 4 years previous hands on application support / dba experience.
3. 1 year prior managed care experience preferred.
:Help Desk Representative
Dept: ITS
Grade: 5
Shift: Days
Location: 37th St
Date Posted: 10/30/2009
Job Summary:
The successful candidate will perform a variety of administrative, technical and customer service related tasks in helping end users in problem resolution. Will serve as the key contact for both on-site and remote systems users for PC and application systems problems and inquiries.
Specific Duties and Responsibilities
• Acts as the key contact point for all end users with problems
• Log all support activities into the incident tracking system
• Triages the problem to the appropriate party for resolution when they can not resolve the problem themselves
• Maintain knowledge of primary software used throughout the organization
• Provides backup support for related positions as needed
• Provide Daily/Weekly reporting relative to helpdesk and call center activity
Required Skills
• Excellent verbal communication skills
• Ability to multi-task and work independently
• Must have the ability to resolve technical issues and address a wide range of questions at the first point of contact by phone or remote support via remote access tools
• Must be able to learn new technical skills
• Must be current in knowledge of Microsoft operating systems and PC hardware/software
• Must have hands-on technical knowledge of laser printers and printer queues
• The ability to work closely with team members and departments
• Must be able to communicate effectively with technical and non-technical people
Required Education and Experience
1. High School Diploma
2. A+ certification is preferred
3. 2 plus years experience troubleshooting hardware and software issues on PC Windows based platform.
4. At least one (1) year help desk experience.
5. Technical knowledge of Microsoft products (O/S, Office. Etc.) a must
6. AA/AS, certificate program or equivalent a plus
:Quality Assurance Analyst
Dept: ITS
Grade: 7
Location: 37th St
Shift: Monday – Friday days
Date Posted: 12/8/09
Job Summary:
The Quality Assurance Analyst will perform a variety of complex technical and administrative tasks to ensure that the ITS department is providing excellent customer service to the organization. Responsibilities include monitoring and testing Application Development and Application Support projects and supporting documentation.
Essential Duties and Responsibilities
• Creating robust and detailed test plans
• Enforcing the ITS Change Control Process
• Monitoring outputs from the ITS department, printed or electronic, for accuracy, timeliness and presentation
• Ensuring that proper QA documentation and policies & procedures exist and are updated as needed
• Ensuring consistency and proper functionality of Application Development and Application Support projects
• Provide backup support for related positions as needed
• Communicate the status of projects in currently in QA to all involved departments and users through emails and status reports
• Create, maintain and provide Metrics on QA activity
• Perform related duties as assigned
• Report environment changes that effect clients (internal or external) to the Director of Application Engineering and QA
• Facilitate fixes through the SDLC
• Track and monitor fixes and reported problems
• Create and manage Release Notes and Communication
Required Skills:
• Excellent written and verbal communication skills
• Ability to work independently
• Detail oriented
• Good all-around information systems knowledge
• Ability to create Test Plans from Functional Specification
• Ability to create Test Cases from a Test Plan
• Ability to create a test matrix based on functionality
• Ability to set up a PC with network connectivity and install products needed to perform job duties
• Ability to explain the project life cycle and Health Plus Methodology
• Understanding of the Health Plus LOBs and general business knowledge
• Understanding of the Health Plus Web Site, where to find templates, etc
• Required Software/Application knowledge: SQL, Web browsers, Visual FoxPro, Business Objects, Crystal Reports, MS Office (Word, Excel, Access, Outlook), Visual Source Safe, Track-it
Required Education and Experience
• BA/BS preferred. AA/AS, certificate program or appropriate work experience
• 4 years of Information Systems experience
:Programmer Analyst-SQL Developer
Dept: ITS-Application Development
Grade: 8
Shift: Monday – Friday 9:00am – 5:00pm
Location: 37th St
Date Posted: Amended 1/22/10
Job Summary:
The Programmer Analyst-SQL Developer will focus primarily on the creation and modification of complex data solutions associated with the development and preparation of SQL based applications that support our organizational needs and operational goals.
Essential Duties and Responsibilities:
• Backend SQL Server Development (Transact SQL).
• Development of SQL based extracts and reports in support of end user needs.
• Development of SQL based solutions to meet organizational, departmental, and 3rd party vendor requirements.
• Experience with SQL Analysis Services or equivalent.
• Creation of Functional documentation and specifications for both technical and non-technical end users.
Other Responsibilities:
• Defining complex business problems and designing usable solutions.
• Designing new workflows, systems, programs and reports to improve processes and operations.
• Performing systems analysis to ensure the feasibility of proposed new programs or program modifications.
• Knowledge of data warehousing.
• Generating test plans for new SQL extracts, applications and/or reports.
• Creating end-user documentation, procedural manuals and technical documentation.
• Developing training materials and contributing to the training process, as necessary.
• Providing comprehensive project updates to both management and end users.
• Knowledge of software development life cycles.
Required Education and Experience:
• A BS in Computer Science or BA with concentration in Computer Information Systems.
• 2+ years work experience as a SQL Programmer/Analyst or equivalent.
• 2+ years experience in using SQL 2000 and/or 2005 or equivalent ANSI structured query language (Transact SQL).
• Excellent oral and written communication skills.
• Ability to work in a dynamic, professional business environment both autonomously and within a team environment.
• Ability to meet deadlines under strict timeframes.
• Ability to take direction.
• A solid understanding of both hardware and software applications.
• Managed care experience helpful.
:Programmer Analyst – SQL Reporting
Dept: ITS
Grade: 8
Shift: Monday – Friday 9:00am – 5:00pm
Location: 37th St
Date Posted: 7/24/09
Primary Responsibilities include:
• Development of SQL based reports within Business Objects and in support of end user needs.
• Development of SQL Data extracts.
• Development of data driven reports to support organizational goals, business needs and end user support within BusinessObjects
• Functional documentation and specifications.
Other Responsibilities will include:
• Defining complex business problems and designing usable solutions
• Designing new workflows, systems, programs and reports to improve processes and operations
• Performing systems analysis to ensure the feasibility of proposed new programs or program modifications
• Development of SQL based solutions to meet organizational, departmental, and end user needs.
• Developing software code in SQL and VB.NET
• Generating test plans for new programs and/or reports
• Creating end-user documentation, procedural manuals and technical documentation
• Developing training materials and contributing to the training process, as necessary
• Providing comprehensive project updates to both management and end users.
Required Education and Experience:
1. A BS in Computer Science or BA with concentration in Computer Information Systems.
2. 2+ years work experience as a Programmer/Analyst or equivalent.
3. 2+ years experience in using SQL 2000 and/or 2005 or equivalent ANSI structured query language.
4. 1+ Years experience using BusinessObjects in a high capacity, data intensive environment.
5. Excellent oral and written communication skills.
6. Ability to work in a dynamic, professional business environment both autonomously and within a team environment.
7. Ability to meet deadlines under strict timeframes.
8. Ability to take direction.
9. A solid understanding of both hardware and software applications.
10. Managed care experience helpful.
:FEEA Coordinator
Department: Medicaid Marketing Department
Level/Grade: 5
Reports to: Director of Marketing
Location: 37th Street
Shift: Variable schedule–Weekend work as needed
Date Posted: 1/15/10
Job Summary:
The FEEA Coordinator is primarily responsible for providing the first line of support for questions and issues that arise from the user population. The primary focus for this role includes being the integral escalation point between the users and the ITS Help Desk.
This position will compile feedback from the internal user population and liaise with the Regional Directors/Managers and ITS Help Desk to analyze feedback and determine a resolution. This individual will consolidate technical information and report back to the internal user population on issue resolutions and status.
Additionally, the Coordinator will act as a backup for the FEEA Training Facilitator when necessary. The incumbent will continually evaluate the work flow within the business and enhance the model and/or make recommendations to streamline processes inside and outside of the software.
Principal Duties and Responsibilities: *Essential Functions
• Serve as the “Go-to” technical expert internally regarding the FEEA software and usability
• Document, track and monitor all issues through to resolution
• Generate daily, weekly and monthly reports for the department Director
• Reconcile completed FEEA applications with paper submissions and LDSS decisions
• Facilitate/instruct training sessions as necessary
• Test new versions of software before release into Production
• Work in conjunction with the designated systems administrator to ensure the latest releases and upgrades are put into production and tested appropriately.
• Identify feedback trends and develop tools to minimize common issues or gaps in training effectiveness
Job Specification:
• Excellent organization skills.
• Excellent written and oral communication skills.
• Must be self-motivated.
• Must be willing and able to work in a multi-cultural and multi-ethnic work environment.
• Ability to work flexible hours (shifts, weekends etc.)
Required Education and Experience:
• At least two years of college or professional training in a health or IT related field or equivalent work experience.
• Managed care and IT experience preferred.
• Bi-lingual skills a plus
:Marketing Assistant
Department: Marketing-Medicaid
Location: Jamaica Queens office –Until Nassau office opens
Grade: 3
Schedule: Variable Schedule- Weekend Work and Overtime as Needed
Date Posted: 1/15/2010
Job Summary:
The Marketing Assistant provides general administrative support to the Marketing Department staff within a particular office/region. Duties include office support, clerical and project based work including maintaining reports.
Principal Duties and Responsibilities: *Essential Functions
• Provides status reports to management on overall Marketing activities and maintains Enrollment data and reports.
• Keeps a record of applications submitted for each Health Plus program, tracks their source, and reports consolidated information on a weekly basis.
• Performs general clerical duties to include but not limited to: photocopying, filing, faxing and mailing, answering phones etc.
• Supports staff in daily workflow needs to include ordering and maintaining supplies for field marketing sites (Applications, flyers, inserts etc.) and for the office.
• Creates and modifies documents using MS Word and Excel.
• Maintains hard copy and electronic filing systems.
• Assists the Special Events Coordinator in preparing for upcoming events and coordinates events logs.
• Assists Marketing Manager with schedule preparation.
• Prepares agendas for weekly meeting between Marketing Manager and Marketing Representatives.
• Manages Marketing Manager’s Organizer and calendar.
• Sets up presentation packages as needed.
• Assists with the preparation for the Articles 44 audit which may occur yearly.
• Other duties as assigned by Marketing Manager.
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.
• Health care, clerical, and some marketing experience preferred.
• Working knowledge of MS Word, Excel programs.
:Marketing Representative (2)
Department: Marketing-Medicaid
Grade: 3
Location: Manhattan Office-Washington Heights (1)
Language: Bilingual-English and Second Language to be determined by Dept
Location: Queens North (1)
Language: Bilingual-English and Second Language to be determined by Dept
Location: Bronx (1)
Language: Bilingual-English/Spanish or other second language identified by Dept
Shift: Variable days and variable hours. You will need to be available to work some weekend and holidays.
Date Posted: 1/15/10
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.
:Medicare Marketing Rep-Asia Mkting (1)
Dept: Marketing Department-Medicare
Shift: Variable Days/Schedule
Location: To be determined
Date Posted: 9/25/09
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 NY State Health Insurance Producer’s 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 required-Chinese languages –Cantonese, Mandarin.
• NY State Health Insurance License is required.
:Medicare Marketing Representative (2 Openings)
Dept: Marketing Department-Medicare
Shift: Variable Days/Schedule
Location: Borough Assignment-TBD
Date Posted: On-Going Posting from March 25, 2009
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.
:Business Representative –Staten Island (1)
Dept: Business Development & Community Relations
Grade: 5
Shift: Variable
Language: English/Bi-lingual a plus
Date Posted: 11/13/09
Job Summary:
The Business Representative is responsible for identifying, targeting, educating, and building relationships with multiple decision-makers in the Business Community, Chambers of Commerce or any organization that or has strong ties in the Business Community in order to market Health Plus programs. Targeting employees of small to large corporations through group education enrollment seminars at the work site for potential eligible uninsured employees and their children to bring them into the managed care plans operated by Health Plus. During the first three months of employment, the Account Business Associate 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, through group educational enrollment seminars done at worksite.
• Understands the overall requirements for Medicaid eligibility, Health Care Plus eligibility and Child Health Plus eligibility.
• Responsible for preparing weekly marketing schedule for any educational seminars needed to be performed of Child Heath Plus, Health Care Plus and Family Health Plus at the worksite.
• Prepares and provides the process for the Marketing Representative (Facilitated Enroller) to attend and participate in the educational seminars at these worksites in order for the Marketing Representative to enroll prospective Members into the three managed care plans operated by Health Plus and assist the Marketing Representatives in reaching their monthly enrollment goals.
• Submits weekly, monthly and quarterly reports to the Business Development Manager for all marketing activities performed and enrollment goals obtained and/or facilitated.
• Helps the Business Development Manager identify potential new markets in the community.
• Works cooperatively with other Marketing staff. Meets overall team efforts.
• Conducts marketing presentations to community organizations, local businesses, pharmacies and providers to inform their staff and clientele about programs and enrollment process.
• Attend Business Networking Meetings and Business Card exchanges usually conducted by the local Chamber of Commerce in the respective Borough assigned.
• Develop general networking, lead generation and potential Marketing Activities through company expos, networking events, street/health fairs and trade shows to reach and promote public awareness of the three managed care plans operated by Health Plus.
• Establish referral and networking relationships with decision-makers in the Business Community in order to increase public awareness of the Health Plus Employed Benefit Program.
• Responsible for maintaining appropriate records, including activity reports and expense reports.
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.
• Ability to work flexible hours (shifts, weekends etc.)
• Bi-lingual a plus.
Required Education and Experience:
Associate’s /Bachelor’s Degree preferred or equivalent combination of education and successful sales/field marketing experience in health care may be considered in lieu of a degree.
• Health care and some field marketing experience preferred.
• Valid Driver’s license required.
:Graphic Designer
Dept: Marketing Communications
Grade: 5
Shift: Variable Schedule/Hours
Location: 37TH Street
Date Posted: 12/8/09
Job Summary:
The Graphic Designer, in conjunction with the Communications & Production Coordinator will complete the design and preparation for the production of Health Plus marketing and communication materials as assigned, including ads, fliers, brochures, handbooks, logo, presentations, etc.
Principal Duties and Responsibilities: *Essential Functions
• Assists the Director of Communications, Communications & Production Coordinators in the design and/or production of Health Plus printed materials. Projects will include brochures, fliers, letters, directories, etc.
• Assists the Director of Communications, Communications and Production Coordinators if required in directing designers, printers, photographers, etc.
• Maintains and keeps inventory of printed materials they prepare or create
• Insures the timely production of all Health Plus materials they prepare or create
• Prepares graphic files for digital prepress
• Designs marketing collateral, if required: brochures, posters, priority fliers, member ID cards, etc.
• Assists the Director of Communications, Communications & Production Coordinators in producing advertising and public relations printed materials
• Other duties as assigned
Job Specification:
• Excellent graphic design skills and strong conceptual thinker
• Must have good organizational skills
• Must be detailed-oriented, be able to prioritize projects and meet tight deadlines
• Should be able to carry out design projects independently from concepts to conclusions.
• Proficiency in using desktop publishing computer programs in Macintosh system (Quark Xpress, Photoshop, Adobe Illustrator, etc.)
• Basic knowledge of DOS –based programs (Word Perfect for Windows 6.0 and PageMaker)
• Knowledge of print terminology
• Should be able to communicate with printers and outside parties
Required Education and Experience:
• Associates Degree, preferably in fine arts, graphic design or related areas. Bachelors degree is preferred
• Portfolio of 10 -15 pieces and/or slides is required
:currently there are no job openings at this department
:currently there are no job openings at this department
:Retention Representative
Department: Marketing
Grade: 3
Location: 37th St.
Language: English/Spanish
Shift: Variable days and Variable Hours
Date: 1/29/2010
Job Summary:
The Recertification/Retention Representative is responsible for the overall follow up and renewal of our members into CHPA &B/FHP as well as the retention of all members who are signed up presumptively into the various plans. This is done through identifying, educating, and re-enrolling qualified individuals and families into the Health Plus programs they qualify for. In addition, enrolls new members when possible. During the first three months of employment, the Recertification/Retention 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:
• Calls up all existing members who are either up for renewal and/or who are due to terminate enrollment because of presumptive eligibility
• Markets Child Health Plus A/B, Health Care Plus and Family Health Plus programs to prospective Members, which may be done on a one-on-one or group basis.
• Follows up with members by mail and conducts house calls if necessary
• Understands the overall requirements for Medicaid eligibility, Health Care Plus eligibility and Child Health Plus A/B eligibility.
• Responsible for assuring that applications are accurately completed and that individuals are actually eligible to be enrolled in the respective programs.
• Works cooperatively with other Marketing staff. Meet overall team efforts.
• Recertification/Retention must conduct enrollment activities.
• Works closely with Member Services and the Call Center.
• Responsible for maintaining appropriate records, including activity 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.
Job Specification:
• Excellent organizational skills.
• Good oral communication skills.
• Must be self-motivated.
• Must be willing to work flexible hours, flexible weekends, holidays and overtime as needed.
• Valid Driver’s license
• Vehicle a plus
• 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 equivalent (G.E.D.) required.
:Special Events Coordinator
Dept: Marketing
Grade: 5
Shift: Variable Schedule/Hours
Location: New York or To Be Determined
Date Posted: 12/8/09
Job Summary:
Under the direct supervision of the Manager, the Special Events Coordinator is responsible for implementing special events, such as health fairs, and enrollment drives.
Principal Duties and Responsibilities: *Essential Functions
• *Assists the Manager of Special Events in identifying and developing marketing opportunities.
• Develops and documents policies and procedures for standard events.
• *Implements special events programs, including on–site supervision of events.
• Collects and analyzes data to determine the effectiveness of special events.
• *Follows annual schedule of special event activities.
• Performs other duties as assigned by Manager of Special Events.
Job Specification:
• Must have good oral communication skills.
• Must have good organizational skills and be able work independently.
Required Education and Experience:
• Minimum one to two years of experience in marketing, sales, special events, fund-raising or related experience. Experience in a health care setting preferred.
• Associate degree preferred.
• This position requires extensive travel throughout Brooklyn, Queens, Bronx, Staten Island and Manhattan; valid driver’s license and use of a personal vehicle required.
• Flexible work schedule, including weekends and holidays.
:Senior Data Analyst
Dept: Medical Director’s Office
Location: Adams Street
Shift: Monday – Friday 9:00am -5:00pm
Grade: 8
Date Posted: 8/07/09
Job Summary
The Senior Data Analyst will assist with the maintenance and update of the Medical Management Department databases, the production and analysis of medical cost trend reports, utilization reports, as well as ad hoc reporting and analysis with respect to disease management programs. Duties and responsibilities will include, but are not limited to, extraction of medical and member data from Health Plus databases, data manipulation and formatting for building and maintaining Decision-Support Warehouses, data maintenance in Microsoft Access Microsoft SQL, generation of reports and analysis problem solving issues related to data sources and quality, and providing support for departmental programs and initiatives.
Specific Duties and Responsibilities:
• Assist with the data manipulation and formatting required for preparing large data sets needed to feed medical management decision-support applications; including the writing of SQL code and the production of formal documentation
• Create and maintain Microsoft Access and SQL databases.
• Generate reports and analysis.
• Problem solving to overcome issues related to data sources and quality
• Provide program support for the medical management department projects and programs concerning utilization, quality and disease management.
• Other duties as assigned.
Required Skills:
• Knowledge and experience with large Microsoft SQL databases.
• Ability to run complex SQL queries access multiple databases
• Understanding of relational and multi-dimensional data design and development techniques.
• Clear understanding of data warehousing concepts.
• Use of Microsoft Vision for data flow design
• Use of macros in Microsoft Excel
• Strong written and verbal communications skills documentation skills
• Demonstrated adaptability and innovation
• Strong interpersonal, organizational, analytical and planning skills
• The incumbent should have a background in computer science, application development and programming plus possess an understanding of the healthcare insurance industry.
Required Education and Experience
• BA or BS degree (Masters preferred) in Information Systems required or Masters in Business Administration, Medical Information, Healthcare Administration, Statistics, or Epidemiology.
• Minimum of five (5) years of experience in database reporting using advance SQL with Microsoft SQL, Sybase or Oracle.
• Minimum of two (2) years of medical claims reporting (three (3) years of non-medical claims reporting may be substituted for the medical claims experience).
• Two (2) years of prior work experience in a managed care organization is preferred
:Health Services Representative
Dept: Medical Management Call Center
Grade: 3
Location: Adams St.
Shift: Days Monday – Friday
Date Posted: 12/23/09
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
:currently there are no job openings at this department
:Member Services Manage Care Clerk (2)
Dept: Member Services
Grade: 2
Location: 37th St
Shift: Monday –Friday 8:00am-4:00pm
Language English and Spanish
Date Posted: 1//15/10
Location: 37th St
Shift: Monday –Friday 9:00am-5:00pm
Language English
Date Posted: 1//15/10
Job Summary:
The Managed Care Clerk for Member Services provides clerical support to the Member Services Department for the coordination of all administrative paperwork.
Principal Duties and Responsibilities: *Essential Functions
Maintains a tracking system for member enrollment, disenrollment, concern forms and PCP change request forms.
Supports the Member Services Department clerically by handling correspondence, specific correspondence for a variety of focused issues, takes messages, schedules meeting, handles photocopying and filing.
Assists in the development of department forms and maintains the form control.
Tracks member concerns and disenrollment in data base.
Performs other duties as assigned.
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 be able to handle multiple tasks simultaneously and require little supervision.
Some computer skills preferred.
Required Education and Experience
High School Diploma or GED required.
At least one year of customer service experience required; health care customer relations preferred.
:Call Center Manager
Dept: Member Services
Grade: 9
Shift: Monday – Friday 9:00am – 5:00pm (flexibility required)
Location: 37TH St.
Date Posted: 12/18/09
Job Summary:
The Member Services Manager, Call Center Operations is responsible for the daily running and management of the member call center through the effective use and scheduling of resources based on in- and out- bound call demand. The Manager is responsible for the supervision of Member Services Supervisors as well as Member Service Representatives. The Manager is the direct link between staff, management and the Director of Member Services.
Principal Duties and Responsibilities: *Essential Functions
• Setting and meeting performance targets for speed, efficiency, production and quality;
• Planning and managing supervisors, seniors and staff to gather information and resolve issues;
• Maintaining up-to-date knowledge of industry developments
• Monitoring random calls to improve quality, minimize errors and track staff and departmental performance;
• Reviewing the performance of staff, identifying training needs and planning training sessions;
• Documenting individual and departmental performance metrics, and the preparation of daily and monthly reports;
• Organizing staffing, including scheduling and the number of staff required to meet anticipated demand and regulatory requirements;
• Coaching, motivating and training staff
• Analyzing data against established performance goals; analyzing performance statistics and making management decisions on the basis of these statistics.
• Establishes and maintains good working relationships with Member Services Staff and various departments.
• Monitors and provides oversight to the call center both inbound and outbound activities which includes productivity, quality and customer service. Oversight of the daily, weekly, and monthly reports and departmental performance metrics.
• Maintains compliance with the City, State and Federal call center standards, i.e. abandonment rate, average speed to answer, percentage of successful contacts, quality and customer service.
• Develops and monitors programs to orient new Health Plus members.
• Collaborates with Health Services and Provider Relations staff and others to identify areas in which members need additional information on how to use services appropriately and implements programs to meet those needs.
• Review and updates all departmental policies and procedures.
• Works within the department and with other departments to improve processes in which the Member Services department is involved.
• Understands the overall requirements for Medicaid eligibility, Health Care Plus, Child Health Plus, Family Health Plus and Health Plus Elite Plans.
• Collaborates with and serves as a backup to the Member Services Manager, Member Care.
• Performs other duties as assigned by the Director of Member Services.
• Call Center Manager must have the flexibility to work a variable schedule/shift/days including some weekends and holidays
Required Skills:
1. Must be willing to work in a multi ethnic work environment.
2. Must have good communication skills and oral presentation skills.
3. Must have good organizational skills
4. Must be self motivated
5. Must present an appearance and demeanor consistent with representing Health Plus in the community.
Required Education and Experience:
1. Bachelor’s degree preferred; appropriate experience may be substitute for educational requirement.
2. Five years of experience in customer relations/customer service
3. Three years of supervisory experience, preferably in a call center environment.
:Member Services Representative (4)
Dept: Member Services
Grade: 3
Location: 37th St
Shift: Monday –Friday 10:00am-6:00pm
Language English/Russian (1)
Date Posted: 1//29/10
Location: 37th St
Shift: Monday –Friday 10:00am-6:00pm
Language English/French/Creole (1)
Date Posted: 1//29/10
Location: TBD
Shift: Tuesday –Saturday 9:00am-5:00pm
Language English/Mandarin/Cantonese (1)
Date Posted: 1/29/10
Location: 37th St
Shift: Tuesday –Saturday 9:00am-5:00pm
Language English & Arabic (1)
Date Posted: 1//29/10
Location: 37th St
Shift: Monday –Friday 8:00am-4:00pm
Language English/Spanish (1)
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
:Telephone Operator
Department: Operations
Grade: 2
Location: Brooklyn
Language: Bilingual – English and Spanish
Shift: Monday – Friday 8:00am - 4:00pm (ability to be flexible preferred)
Date Posted: 12/11/09
Job Summary:
• This position is responsible for all incoming calls in a professional and courteous manner and directing calls to the appropriate person or department.
Principal Duties and Responsibilities: *Essential Functions
• Professionally and courteously answer all incoming calls.
• Ensures all telephone calls are directed to the appropriate person or department.
Job Specification:
• Professional telephone manner.
• Excellent verbal communication skills.
• Able to work with minimum supervision.
• Knowledge of Microsoft Office, work, Outlook.
Required Education and Experience:
• High School diploma or equivalent.
• 1 year switchboard telephone and customer service experience.
:Provider Relations Associate(1)
Dept: Provider Relations
Grade: 6
Location: Bronx, TBA
Language: English/Mandarin/Cantonese
Shift: Monday – Friday 9:00AM – 5:00PM
Date Posted: 9/11/09
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 for his/her region, the Provider Relations Associate assists in the recruitment and orientation of HEALTH PLUS providers. The Provider Relations Associate is also responsible for maintaining ongoing contact with providers and their office staff.
Principal Duties and Responsibilities: *Essential Functions
• Assists in identifying, recruiting and negotiating contracts with network providers
• Implements programs to orient providers and provider office staff to HEALTH PLUS
• Assists in the development and implementation of educational programs for provider and provider staff
• Monitors provider corrective action plans
• Distributes provider manuals and orients provider staff to manuals
• Responds to provider inquiries and complaints
• Implements provider surveys
• Assists with the credentialing process
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 know WordPerfect or 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
• This position will require frequent travel within the New York metropolitan area and will require use of a personal vehicle
Required Education and Experience:
• B.A. or B.S. degree
• Three years experience in health care delivery or insurance with at least one year experience in a managed care organization
:Field Supervisor
Dept: Provider Services
Grade: 8
Location: TBD
Shift: Monday – Friday
Date Posted: 6/26/09
Job Summary:
The Provider Relations Field Supervisor is responsible for overseeing the field activities of the Provider Relations Associates
Principal Duties and Responsibilities: *Essential Functions
• Provides Field Supervision to Provider Relations Associates
• Assists Provider Relations Associates in provider recruitment
• Responsible for field training of Provider Relations Associates
• Responsible for monitoring the field activities of Provider Relations Associates
• Responsible for addressing any issues that develop between Provider Relations and the Providers’ staff
• Responsible for insuring that all directly contracted PCPs in their service area have quarterly visits by Provider Relations Associates
• Responsible for insuring that all facilities have monthly visits
• In conjunction with Provider Relations Managers, identifies areas in need of primary care and specialist referrals
• Insures that Provider Relations Associates submit provider updates on a timely basis
• Reviews all provider complaints for providers in service area and ensures timely responses
• Assist Provider Relations Associates in claims research
• Conduct provider orientations for large groups/facilities
• Other activities and duties as assigned by the Director of Network Management and Provider Relations and the Provider Relations Manager
• Project Manager for Corporate Initiatives 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 excellent written and oral communication skills, including experience in large group presentations.
• Must have excellent computer skills. Must know Microsoft Word and Excel for Windows.
Required Education and Experience:
• B.A or B.S. degree
• Two years experience in Provider Relations or related field within a managed care organization
:Medical Auditor Reviewer
Dept: Quality Improvement
Grade: 6
Location: Field Position base out of the Adams St Office
Shift: Monday – Friday
Date Posted: 12/23/09
Job Summary:
The Medical Auditor Reviewer position is a field position requiring approximately 80% travel and the remaining 20% is spent in the office completing field visit paperwork, QARR projects and various departmental coding projects. Travel to Health Plus provider sites consists of chart duplication, medical record reviews and written analysis of findings for the purposes of evaluating compliance with established health care standards. Health Plus providers are located in the 5 boroughs of NYC and Nassau County. The Medical Auditor Reviewer audits member medical records received from providers to verify and ensure appropriate and accurate claims diagnosis and procedural data in compliance with specific guidelines. Additionally, the Medical Auditor Reviewer will be responsible for making recommendations pertinent to coding appeals utilizing standard coding guidelines.
Essential Duties and Functions:
• Reviews and audits Health Plus member medical records, medical record duplication and claims data analysis to ensure accurate assignment of ICD-9-CM, CPT-4 and HCPCS coding in accordance with regulatory established coding guidelines
• Interacts with Health Plus providers to identify coding inaccuracies, recommends corrective action and provide documentation and coding training in accordance with established guidelines.
• Review and complete coding appeals utilizing various coding tools and established coding guidelines
• Perform other duties as required by the department
Job Specific Experience:
• One to three years full-time paid experience of progressive coding or chart auditing in one of the following health care delivery settings: inpatient hospital, outpatient hospital or physician’s private practice and one to three years of full-time paid experience as a claims examiner/medical biller.
• Working knowledge of ICD-9-CM, HCPCS and CPT-4 coding books to research/verify diagnosis codes (ICD-9-CM) and/or procedure codes (HCPCS and CPT-4) acquired through work experience, academic classes/training, or participation in the American Academy of Professional Coders or the American Health Information Management Association curriculum to qualify to sit for the coder’s exam.
• Working knowledge of CMS’ Local Coverage Determinations (LCD), National Coverage Determinations (NCD), Correct Coding Initiative Guidelines (CCI) and DOH pertinent to HCPCS, CPT-4 and ICD-9-CM coding and billing regulations.
• Working knowledge of anatomy, physiology, medical terminology, abbreviations, diseases, illnesses, and injury processes.
• Working knowledge of Health Plan Effectiveness Data and Information Set (HEDIS) and NYS Quality Assurance Reporting Requirements (QARR) measures is preferred.
• Must possess excellent oral, written, interpersonal and professional face-to-face and telephone customer service skills.
• Working knowledge of coding software such as Encode Pro, 3M or Decision Coders.
• Proficient in computer skills (keyboarding and all Microsoft Office suite applications are a must).
Educational Requirements:
1. An Associate’s Degree from an accredited college or university in Health Administration, Health Information Management, Business Administration, Public Administration or other approved related program is preferred.
2. Coding certification (CPC, CPC-H, CPC-P, CCS, CCS-P or RHIT) may be substituted for
Degree with full time paid experience as indicated in job specific experience
:Sr. Medical Auditor Reviewer
Dept: Quality Improvement
Grade: 7
Location: Field Position base out of the Adams St Office
Shift: Monday – Friday
Date Posted: 12/23/09
Job Summary:
The Senior Medical Auditor Reviewer is a position that requires an individual who can be Team Lead working closely with both the Senior Medical Auditor Reviewer Manager and to provide guidance to the coding staff. The position requires approximately 60% travel time, 20% office time working closely with Coding dept staff and 20% working closely with the Manager assisting with various departmental coding projects and identifying areas for quality assurance coding improvement. The position requires travel to Health Plus provider offices to perform chart duplication, medical record reviews and written analysis of findings for the purposes of evaluating compliance with established health care standards. Health Plus providers are located in the 5 boroughs of NYC and Nassau County.
Essential Duties and Functions:
• Reviews and audits Health Plus member medical records, medical record duplication and claims data analysis to ensure accurate assignment of ICD-9-CM, CPT-4 and HCPCS coding in accordance with regulatory established coding guidelines
• Interacts with Health Plus providers to identify coding inaccuracies, recommend corrective action and provide documentation and coding training in accordance with established guidelines
• Generates coding project reports and distributes to staff as needed
• Assists Medical Auditor Manager in identifying coding inaccuracies and makes recommendations for resolution.
• Serves as Team Lead and backup liaison for the Quality Improvement Coding Department and will interact with various levels of the organization such as Claims Department, Provider Relations and Model Office regarding various coding issues.
• Ensures timely distribution of coding appeals, ensures timely completion and review of appeals utilizing standard coding guidelines prior to submission to the Claims Dept.
• Participates in committee meetings pertinent to documentation and coding activities.
• Provide ongoing training and re-orientation as necessary to current staff and orient new coding staff.
• Perform other duties as required by the department
Job Specific Experience:
• Minimum of 5+ years full-time paid experience of progressive coding or chart auditing in one of the following health care delivery settings: inpatient hospital, outpatient hospital or physician’s private practice and 5+ years of full-time paid experience as a claims examiner/medical biller.
• Proficient in ICD-9-CM, HCPCS and CPT-4 coding books to research/verify diagnosis codes (ICD-9-CM) and/or procedure codes (HCPCS and CPT-4) acquired through work experience, academic classes/training, or participation in the American Academy of Professional Coders or the American Health Information Management Association curriculum to qualify to sit for the coder’s exam.
• Proficient with CMS’ Local Coverage Determinations (LCD), National Coverage Determinations (NCD), Correct Coding Initiative Guidelines (CCI) and DOH pertinent to HCPCS, CPT-4 and ICD-9-CM coding and billing regulations.
• Extremely proficient in coding software such as Encoder Pro, 3M or Decision Coder
• Proficient in Health Plan Effectiveness Data and Information Set (HEDIS) and NYS Quality Assurance Reporting Requirements(QARR) measures
• Working knowledge of RAPS and risk adjustment HCC Coding guidelines
• Proficient in anatomy, physiology, medical terminology, abbreviations, disease, illness, and injury processes
• Must be extremely proficient in computer skills (keyboarding and all Microsoft Office suite applications are a must).
• Must possess the ability to work independently with minimal guidance and supervision and possess effective teamwork skills
• Must possess excellent oral, written, interpersonal and professional face-to-face and telephone customer service skills.
• Must possess project management and time management skills.
Educational Requirements:
1. A Bachelor’s Degree from an accredited college or university in Health Administration, Health Information Management, Business Administration, Public Administration or other approved related program is preferred.
2. Dual coding certification (CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT or RHIA) may be
substituted for Degree with full time paid experience as indicated in job specific experience.
:QI Coordinator
Dept: QI
Grade: 8
Shift: Monday – Fridays days with some overtime required
Location: field position based out of Adams St
Date Posted: 12/8/09
Job Summary:
The Quality Care Coordinator is a staff position that, in conjunction with the Director of Quality Improvement and the Quality Improvement Manager is responsible for assessment of clinical management and the implementation of Quality Improvement studies in provider’s offices and centers of care throughout the HEALTH PLUS network
Principal Duties and Responsibilities: *Essential Functions
• In conjunction with the Director and Manager of Quality Improvement, assists in implementing and conducting Quality Improvement studies throughout the network
• Responsible for completing the primary care provider medical record review for recredentialing
• Conducts medical record reviews
• Responsible for the identification of specific Quality of Care issues and trends in Quality Issues found in medical record review
• Monitors Quality of Care in the inpatient hospital center using clinical indicators to identify, track and trend Quality of Care Concerns.
• Responsible for assessing the coordination of care provided by primary care providers
• Reports finding to the Director of Quality Improvement, the Quality Improvement Manager, and the Quality Improvement Committee
• Collects, analyzes and displays data used in the Quality Improvement process
• Monitors clinical quality indicators
• Reviews all sources of input (e.g., complaints, member satisfaction surveys, utilization management reports, and feedback from providers, marketing and member services staff) to identify problems or potential problems for Quality Improvement intervention
• Tracks and monitors corrective action plans
• Responsible for entry of data collected for QARR/HEDIS
• Other activities and duties as assigned by the Director of Quality Improvement and the Quality Improvement Manager
Job Specification:
• Must be able to work with people at all levels within the organization and facilitate work group processes
• Must have excellent written and oral presentation skills
• Must have clinical knowledge in a medical or surgical specialty
• Must have experience in medical record auditing using structured criteria
• Must be familiar with clinical guidelines
Required Education and Experience:
• Medical Physician, or Physician Assistant, or a foreign medical grad
• Minimum of five (5) years clinical experience of which two (2) years must have been in an inpatient setting
• Minimum of two (2) years of Quality Assurance experience or two (2) years of Case Management experience
• Experience in Managed Care Organization is preferable
:currently there are no job openings at this department
:currently there are no job openings at this department
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What is Health Plus?
