Location
Schenectady, NY | United States
Job description
Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds—tech people, numbers people, even people people—working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference—it’s time to make a healthy career move to MVP!
Status: Full Time, Exempt
Performs Retrospective Review for inpatient admissions and outpatient services which includes claim review for all regions. Completes Retrospective Review for medical necessity and appropriateness of care as based on predetermined criteria and/or guidelines. Knows and interprets MVP contracts, policies and procedures and InterQual Criteria. Discuss complex cases with the Leaders and Medical Directors. Assists with the coordination of the monthly UM retrospective reports. Research, coordinates, and completes special projects for the Leader. Recommends revisions in the UM process to ensure the maximum level of automation, efficient time utilization and data quality. Completes other duties regarding UM/Health Services functions as assigned.
This position is preferred to be worked as a hybrid position - a combination of working remotely (virtually) with the ability to work from one of our NY/VT office locations as needed. Location near one of MVPs administrative New York state locations strongly preferred (Schenectady, Rochester, Tarrytown). Full-time Virtual work may be considered.
POSITION QUALIFICATIONS
Minimum Education: Current NYS RN license required
BS in health management or administration is preferred
Minimum Experience: 3+ years strong clinical background required
Minimum of 1-year DRG auditing experience preferred
Minimum 1-year UM experience preferred
Required Skills: - Knowledgeable in ICD-10 Diagnoses and Procedural Coding Guidelines
- Ability to perform critical audits of medical records applying coding guidelines and
clinical picture to validate code assignment
- Proven success with interacting with providers on delicate matters of medical
necessity and service appropriateness.
- Demonstrated problem-solving skills with excellent verbal and written communication
abilities.
- Independent thought process; oriented toward probing/case coordination.
- Strong PC skills.
- Able to manage multiple tasks in a fast-paced environment.
- Excellent verbal and written communication skills.
Preferred Skills: - Familiarity with InterQual Criteria preferred.
About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve.
At MVP, we are committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. Specific employment offers and associated compensation will be made individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.
In addition, we offer a comprehensive benefits package that includes:
- Considerable paid time away from work including PTO (Paid Time Off), sick time, service time off, paid holidays, and floating holidays, allowing you to take time off when it suits you best.
- Competitive 401(k) employer matching and profit-sharing program to help you save for your retirement.
- Low premium health benefits including medical, dental, and vision coverage to support your well-being and that of your family.
- Life insurance and disability coverage to ensure financial security for you and your dependents.
- An array of optional benefit plans such as accident insurance and specified disease coverage to protect you from the unexpected.
- Full tuition reimbursement (up to the IRS limit) for approved courses and programs that support continuous learning.
- A best-in-class employee Well-Being program to support all dimensions of your health and wellness.
MVP Health Care analyzes the latest market data to determine employee compensation. Compensation figures listed in a job posting are subject to change as new market data becomes available. The salary range, other compensation, and benefits information is accurate as of the date of this posting. MVP Health Care reserves the right to modify this information at any time, subject to applicable law. More detailed information about totalcompensation and benefits will be provided during the hiring process.
MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at
[email protected] Please apply and learn more – including how you may become a proud member of our team.
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