Quality Assurance Analyst

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

This QA Analyst will be responsible for reviewing the Claims Processing Systems for configured benefits, and reimbursement methodologies. Experienced candidates must demonstrate working understanding of claims processing systems and working knowledge of the health care industry.

• Test and QA Configuration changes to the systems to meet regulatory requirements and business needs
• Test and QA system changes and upgrades made by system vendor
• Monitor and QA provider contract changes
• Meet with business areas to gather business rules and requirements
• Create and maintain documents related to testing and QA
• Analyze business processes to improve efficiencies

• A Baccalaureate Degree from an accredited college or university; and
• Five (5) years of progressive, responsible experience in configuration for data processing, computer systems and applications; and
• Knowledge and expertise in the characteristics of IT applications and systems analysis methodology.
• Knowledge of Managed Health Care MIS Systems; and
• Knowledge of EDI standard transactions; or
• A satisfactory equivalent combination of training, education, and experience.
• Excellent verbal and written communication skills.
• Excellent analytical ability.
• Excellent interpersonal, customer service and time management skills

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication