MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Works with SS&C, vendors and payors on all EDI transactions. Troubleshoot issues and works with vendors on changes and enhancements.
- Responsible for configuring, testing, maintaining, enhancing, and supporting HIPAA EDI (837, 835, 834, 270, 271, 276, 277, 278) transactions and applications.
- Implement new and update existing Companion Guides and Trading Partner Agreements
- Supported day-to-day operations of EDI, including identifying any technical problems with sending/receiving transactions
- Interfaced with providers, vendors and internal departments to address technical issues related to EDI
- Review electronic data received from providers/vendors to ensure presence and accuracy of critical data elements
- Ongoing review of system setup and processes to ensure accurate and optimum setup for both provider and member selection
- Bachelor’s Degree in Computer Science or a related technical discipline, or the equivalent combination of education, technical certifications or training, or work experience.
- Minimum two years of full-time experience analyzing health care related data in a health-care environment.
- Experience with HIPAA data transaction required
- Must be able to work independently and to attend to detail.
- Proficient in use of Microsoft Office applications including Word, Excel, SQL and Access. Ability to run Access queries required.
- Requires excellent written and verbal communication skills as well as strong project management and data analysis skills.
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication