Growth opportunities to uplevel your careerA people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our teamCompetitive compensation and comprehensive benefits focused on well-beingAn opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District , one of the Best Companies to Work For in New York , and an Inclusive Workplace .Qualifications you'll bring:High School Diploma required. Associate degree in health, Business or related field preferred
The availability to work Full-Time, Virtual in Schenectady or Rochester
Previous related health care experience required
Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred.
Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail.
Curiosity to foster innovation and pave the way for growth
Humility to play as a team
Commitment to being the difference for our customers in every interaction
Your key responsibilities:
Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems.
Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible.
Knowledge of Facets and Macess systems strongly preferred, but not required.
Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information.
Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination.
Meets or exceeds department quality and work management standards for claims adjudication.
Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy.
Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments.
Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback.
Keeps abreast of all benefit changes.
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Where you'll be:
Virtual within Rochester, NY or Schenectady, NY
Pay Transparency
We do not request current or historical salary information from candidates.
$20.00-$26.60
MVP's Inclusion Statement
Health insurance
Equity / stock options
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.
Mvphealthcare · Remote