MVP Health Care

The specialist conducts RPA and manual verifications, processing credentialing and recredentialing applications for providers and facilities according to MVP Policies and regulatory standards. Key duties include performing primary source verifications, managing documentation, data entry into credentialing software, and acting as a liaison between various departments.

The specialist will review and process quality of care concerns, complaints, and appeals filed by regulatory agencies, ensuring thorough investigation and compliance with State and Federal regulations. This role involves collaborating with the Legal department to prepare cases for Fair Hearings and liaising with internal/external stakeholders to gather necessary documentation.

The Appeals Specialist will review and analyze appeal requests, investigate complex appeals, and ensure compliance with State and Federal regulations, including accreditation requirements. Key duties involve collaborating with stakeholders, maintaining accurate records, preparing correspondence, and assisting clients with the appeals process.

The Senior Quality Data Analyst will lead and oversee operational workflows within the Health Care Quality Analytics team, ensuring the delivery of routine and ad hoc analyses and data visualizations to support MVP’s health care quality functional area. Responsibilities include working with HEDIS, Medicare Stars, and NYSDOH QARR measures data, conducting analysis of large datasets, and collaborating with cross-functional teams on data solutions.

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 cur...

This role involves testing and auditing health care claims and configurations to ensure accurate provider reimbursement and benefit plan requirements. Responsible for the accurate and timely testing of configuration required for provider reimbursement, adjudication rules, and ben...