Be a part of the transformation at MVP Health Care.    This position is a critical part of this transformation.  As a member of a Scrum team, this role is primarily responsible for that ensuring quality products are delivered to the...

Responsible for electronic filing and distribution within the document retention system of all documentation received within the Clinical Operations Support Intake Unit. Retrieves medical documentation from files when necessary and prepares it for...

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....

This position will be responsible for overseeing the strategic development, implementation and evaluation of MVP’s Provider Excellence and Value Based Purchasing Programs. In this capacity, the role will work with Informatics, Product...

The Configuration Analyst develops and implements configuration into the Facets system to accommodate systematic adjudication rules and benefit plan requirements. Responsible for the interpretation of requests, development of solutions and creation...

Thoroughly investigates and resolves member appeals in a professional and timely manner following departmental and company processes and within time limits set forth by state guidelines. Monitors appeals for trends and potential service improvement...

Performs paralegal functions for the Legal Affairs Department. Prepares correspondence, reports, contracts, corporate documents and other legal documents.  Conducts legal research.  Compiles information for and prepares reports and...

This role will analyze, triage and process SIU referrals received from both internal and external sources to MVP, assisting in the investigative process. Upon completion of the review, the role will recommend whether the issue warrants further...

Provides direct support to Appeals management related to the interpretation of and requirements needed to meet new and/or changing regulatory requirements as released. Documents new and existing processes, work flow management and outcomes-based...

Position executes and maintains oversight of Physical or Behavioral Health related compliance projects/programs for the Integrated Health Services unit and supports the Compliance Coordinators. Provides direction, implementation support, and...

Serves as the subject matter expert on products assigned including thorough analysis of all aspects of product performance, design, and regulatory compliance. Products may include Medicare, Commercial, and/or Enterprise-wide capabilities and...

Serves as program manager for the operational components of Behavioral Health (BH) insourcing including providing expertise and support to the IH team to help build out the department and create innovative programs and pilots. Ensures that all...

Responsible for Premium Billing and Collections reporting and data analytics. Supports ongoing business activities and process improvement efforts through data collection and analysis, database development, forms and report development and metric...

This role develops and implements configuration into the Facets system to accommodate systematic provider reimbursement, adjudication rules and benefit plan requirements. Responsible for the interpretation of requests, development of solutions and...

Responsible for outreach and promotion of MVP lines of business to individuals and community groups from target market. Supervises diverse team of outreach representatives. Ensure that the Team’s productivity meets projected targets. Works...

Responsible for ASO stop loss policy administration including specific claimant identification, completion of notification forms, and claims filing to ensure MVP meets its contractual and fiduciary responsibilities. The role is responsible for...

The role will be responsible for driving the successful activation and adoption of Dynamics365 CRM throughout the enterprise – this will be achieved by acting as the hero/ambassador/champion/coach for MVP departments and stakeholders;...

This role is responsible for developing reports and analysis for consumption by internal and external department customers using a variety of company data sources in support of the information requirements for the Operations Department including...

Perform general ledger functions to assist with monthly accounting activity and closings. Prepare monthly reconciliations of balance sheet accounts to the general ledger including proactively detecting, researching, and resolving reconciliation...

Conducts detailed competitive, market, trend, and financial analysis. Builds and populates market share and financial reports. Supports production, maintenance, continuous improvement and distribution of the Corporate Scorecard. Participates in...

Tracks and influences the services provided to MVP members as they move through the continuum of care. Reviews inpatient medical records against established criteria and standards to determine medical appropriateness and level of care assignment....