Professional, Member Ops Billing Specialist

About the role

The Professional, Member Ops Billing plays a strategic role as a subject matter expert in leading complex projects, audits, and automation initiatives within the billing team. This position collaborates closely with Digital Transformation & Technology and business stakeholders to define, implement, and manage automation solutions that enhance operational efficiency and accuracy. Provide direction related to billing, cash application, collections, and account reconciliations for designated business categories, including New York State of Health populations (e.g., Child Health Plus, Essential Plan, On Exchange/Qualified Health Plans), commercial populations, and other government programs populations. Ensure compliance with government regulations and participate as a critical resource in the development, implementation, communication, and maintenance of A/R operating policies and procedures, ensuring sufficient internal controls are in place. The professional will have significant understanding of the applicable processes and systems.

Responsibilities

• Lead audits such as DOH, SOC, and Model Audit Rule (MAR)
• Analyze and interpret data from Commercial, On/Off-Exchange, and Medicare reports
• Participate in and play a lead role in project meetings and initiatives
• Develop and manage testing plans for system enhancements and invoice validation
• Train and support team members on new processes and tools
• Collaborate with Digital Transformation & Technology to define automation requirements and workflows
• Evaluate and implement AI tools for tasks such as reconciliations, refunds, and data validation
• Monitor and manage AI-driven processes and escalate issues as needed
• Document automation use cases, outcomes, and continuous improvement opportunities
• Other duties as assigned by leadership

Requirements

• Education, Licensures, & Certifications
• Bachelor's degree in Business, Information Systems, or related field required
• Years of Experience (Required & Preferred)
• 3-5 years of experience in healthcare operations, billing, financial, or customer service role required
• 1-2 years of experience working with Information Technology or automation projects
• Required Job Skills
• Strong analytical and problem-solving skills
• Experience in data analytics and reporting tools
• Ability to serve as a key stakeholder in cross-functional projects and communicate with technical teams
• Understanding of billing workflows
• Interest or familiarity with AI concepts and automation tools
• Preferred Job Skills
• Knowledge of healthcare compliance and audit standards
• Hands-on experience with AI preferred
• Pay Transparency
• We do not request current or historical salary information from candidates.
• $51,395.00-$68,354.75
• MVP's Inclusion Statement
• At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all wa

Benefits

Additional Information

Join Us in Shaping the Future of Health Care At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team.

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