Assists in the configuration and maintenance of the claims system used to administer operations of current and new business for VNSNY CHOICE products. Translates business rules to action. Analyzes, documents, and tests all new configurations. Assists in preparing and delivering reports, recommendations, and updates/revisions to address existing and potential issues in related processes across the organization.
Assists in the completion of system configuration in accordance with contractual agreements and implements into production. Provides support in all phases of the systems project life cycle including monitoring project tasks, documentation of requirements, testing, training and roll out.
Works with Compliance to identify new state and federal regulations and ensures system configurations comply with CMS standards and DOH regulations. Develops/updates audit programs to ensure product and program compliance.
Collaborates with internal departments and external vendors to ensure that annual benefit updates and pricing configurations are mapped, tested, documented, and loaded into production prior to the effective date of the contract. Ensures that fees and coverage rules are implemented annually or more often if dictated by regulating body.
Validates that codes (CPT, HCPC, ICD Diagnosis, ICD Procedure) are mapped, tested, documented, and loaded into production annually, prior to the effective date of the coding group. Completes updates periodically as deemed appropriate by regulating body.
Maintains current versions of Benefit Grids for all VNSNY CHOICE products. Disseminates communication on implementation of benefit changes and new benefits to staff.
Provides support in ensuring that pricing software is updated regularly, tested, logged, and functioning properly in production.
Assists in the development of reports and analyzes data to research/correct discrepancies. Monitors postimplementation reports to identify and fix configuration issues.
Assists in the coordination, maintenance and development of various technical processes (such as EDI, check processing, EOB) as they relate to system configuration.
Education: Associate’s degree in Business Administration, Healthcare Administration, a related field or the equivalent work experience required. Master’s degree in related field preferred.
Experience: Minimum of three years managed health care operations experience required. Experience with health care information system development required. Experience managing complex projects across departments required. Effective communication skills, both written and oral, and proficiency in PC software applications (i.e. Microsoft Office) required.
The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Countries. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost effective healthcare in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life. Each day, more than 13,000 VNSNY employees - including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 44,000 patients and members, helping them to live the best lives possible in their homes and communities.