Professional, Member Ops Billing Specialist

About the role

The Professional, Member Ops Billing plays a strategic role as a subject matter expert in leading complex projects, audits, and automation initiatives within the billing team. This position collaborates closely with Digital Transformation & Technology and business stakeholders to define, implement, and manage automation solutions that enhance operational efficiency and accuracy.

Responsibilities

• Lead audits such as DOH, SOC, and Model Audit Rule
• Analyze and interpret data from Commercial, On/Off-Exchange, and Medicare reports
• Participate in and play a lead role in project meetings and initiatives
• Develop and manage testing plans for system enhancements and invoice validation
• Train and support team members on new processes and tools
• Collaborate with Digital Transformation & Technology to define automation requirements and workflows
• Evaluate and implement AI tools for tasks such as reconciliations, refunds, and data validation
• Monitor and manage AI-driven processes and escalate issues as needed
• Document automation use cases, outcomes, and continuous improvement opportunities

Requirements

The professional will have significant understanding of the applicable processes and systems. Specific requirements include:

• Education, Licensures, & Certifications: Bachelor's degree in Business, Information Systems, or related field required
• Years of Experience: 3-5 years of experience in healthcare operations, billing, financial, or customer service role required
• Skills: Strong analytical and problem-solving skills, experience in data analytics and reporting tools, ability to serve as a key stakeholder in cross-functional projects and communicate with technical teams, understanding of billing workflows, interest or familiarity with AI concepts and automation tools

Qualifications

Qualifications include:

• Knowledge of healthcare compliance and audit standards
• Hands-on experience with AI preferred

Skills

Skills include:

• Strong analytical and problem-solving skills
• Experience in data analytics and reporting tools
• Ability to serve as a key stakeholder in cross-functional projects and communicate with technical teams
• Understanding of billing workflows
• Interest or familiarity with AI concepts and automation tools

Benefits

Pay Transparency: MVP Health Care is 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. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended 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.

Pay Range: $51,395.00-$68,354.75

Benefits

At MVP Health Care, we offer a comprehensive benefits package designed to support your well-being and that of your loved ones. This includes:

• Competitive compensation and comprehensive benefits focused on well-being
• 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

Pay

$51,395.00-$68,354.75

Schedule

Not specified