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analyst, case management – transition of care (care coordinator) Jobs in New York

business systems analyst medicare enrollment processing

Centene

<div><p>You could be the one who changes everything for our 28 million members by using technology to improve health outcomes around the world. As a diversified, national organization, Centene's technology professionals have access to competitive benefits including a fresh perspective on workplace flexibility.<br>
</p><p><b>Position Purpose:</b> With the corporate enrollment Medicare team, you will design, build, test and maintain enablers of business processes, including technology and process solutions with a focus on medium complexity, multiple application business processes and/or business relationships</p><ul><li>
Contribute to in the entire implementation process</li><li>
Drive definition of improvements based on business need and architectural improvements</li><li>
Responsible for build and test, root cause analysis, and complex performance tuning</li><li>
Consult with users to identify current operating procedures and to clarify program objectives</li><li>
May be expected to write documentation to describe program development, logic, coding, and corrections. Write manuals for users to describe installation and operating procedures</li></ul><b>
Education/Experience:</b> Bachelor's degree in Computer Science, MIS, related field or equivalent experience. 2+ years of related experience. Knowledge of programming languages, project management, and application or systems development methodologies. Basic SQL query skills.Pay Range: $70,100.00 - $126,200.00 per year<p>
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.</p><p>
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.</p><p><br>
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act</p></div>

Business Systems Analyst - Medicare Enrollment Processing

MJHS

<div>
 Come lead with us at New York, NY
 <br/>
 <br/>
 The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Even in a non-clinical role, Elderplan employees have an opportunity to make a positive impact on the quality of our health plan members' lives.
 <br/>
 <br/>
 The Business Operations Analyst provides support to the Network Provider Operations department with daily operations, project initiatives, system updates, special projects, and all regulatory reporting and analysis. The Analyst will audit departmental operations with a focus on data integrity, improving accuracy, and identifying training opportunities for department. Responsible for preparation and submission of all Provider Network Regulatory Reporting. Develop and run extracts to support departmental operational reporting. Lead system upgrades and implementations for the department, and provide technical support as needed. Collaborate with existing technical EPIS structure.
 <br/>
 <br/>
 <ul>
  <li>
   High school diploma
  </li>
  <li>
   Asociates Degree or Bachelors Degree in health/business related field preferred
  </li>
  <li>
   3-5 years of experience in a managed care environment
  </li>
  <li>
   Experience with working with technology, systems, provider and/or claims data
  </li>
  <li>
   Experience with data, trending, and qualitative analysis
  </li>
  <li>
   Familiarity with Medicaid and Medicare regulations
  </li>
  <li>
   Experience with geo access analysis and regulatory reporting
  </li>
  <li>
   Experience with generating files and reviewing quality for provider directories
  </li>
  <li>
   Required: Microsoft Word, Excel, Access, and Visio. SQL.
  </li>
  <li>
   Preferred: Visual CACTUS, HealthRules Payor, Quest Analytics, and Optum GeoAccess Suite
  </li>
  <li>
   Knowledge of provider data entry and credentialing process
  </li>
  <li>
   Ability to utilize Access and SQL to program and execute queries to support data structure and analysis, including tracking and trending on errors
  </li>
  <li>
   Excellent verbal and written communciation skills
  </li>
  <li>
   Ability to evaluate system set-up and files to determine whether changes are needed to process correctl
  </li>
  <li>
   Ability to handle multiple deliverables and to meet strict reporting timeframes
  </li>
  <li>
   Knowledge of NY regulatory reports
  </li>
 </ul>
</div>


Business Operations Analyst

Healthfirst (New York)

<div>T he Entitlement Advocate provides Healthfirst Medicare Advantage Plan(MAP), Managed Long-Term Care Plan(LTC), Dual eligible Medicare Plan and Nursing Home members and prospects with obtaining and retaining of financial entitlements for which they are eligible. This enables prospects and members to maintain the highest level of independence both at home and within their communities. Working under the direction of the Entitlement Manager and Team Leads, maneuvers multiple tasks independently with a fast paced proactive vs. reactive approach to changing priorities. Frequently communicates moderately complex information and interacts through electronic documentation tools. This is a paperless work environment requiring daily hands-on administration of multiple electronic Patient Health Information databases and security requirement tools such as encryption.<p><b>
Duties and Responsibilities</b></p><ul><li>
Handle inbound and outbound calls to and from customers to address their needs while adhering to our service level goals.</li><li>
Screen all incoming calls and handles accordingly.</li><li>
Transfer calls to appropriate staff, unit, or department.</li><li>
Assist callers requesting assistance with Medicaid Renewal application, Medicare Savings Program application, and New Medicaid Applications.</li><li>
Outreach Senior Health Partners, CompleteCare, and Life Improvement Plan members according to approved scripts.</li><li>
Research ePACES and/or Marx for Medicaid and Medicare eligibility, exclusion, and exemption codes.</li><li>
Consult with HRA Medicaid staff as needed and report to supervisor any need for HRA consultation.</li><li>
Document all client calls /outcomes in database systems.</li><li>
Schedule appointments to see members/prospects out in the field to assist with Medicaid Issue or restriction code removals or demographic information changes</li></ul><p></p><p>
Growth (Educate and Assess for Medicaid Eligibility):</p><ul><li>
Educate potential members on Senior Health Partners, Long term care plan benefits answering questions regarding plan&rsquo;s features and benefits as well as go through eligibility and requirement for enrollment.</li><li>
Transfer and connect consumers seeking Long Term Care services with the state broker to complete initial evaluation (New York Independent Assessor).</li><li>
Contact prospects or primary caregiver in person (home or Community Office visit), by phone or letter to arrange an interview to assess Medicaid eligibility.</li><li>
Complete Medicaid applications for New Enrollees and Renewals as needed.</li><li>
Assist prospects to remove Medicaid restriction codes.</li><li>
Assist prospects to Convert Market place Medicaid to Community Medicaid.</li><li>
Facilitate compilation of all required documents. Call, write or in person contacts landlords, employers, bankers, insurance companies, etc. to obtain required documents.</li><li>
Submit documentation to Human Resource Administration or Local Department of Social Services within specified timeframe.</li><li>
Track Medicaid conversions and coverage of all submitted Applications and update status in systems.</li><li>
Serve as the liaison between all parties and acts as Member advocate maximizing the participant&rsquo;s support network and obtaining needed services.</li><li>
Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, calling for the utmost integrity at all times.</li><li>
Serve as a resource for Welcome Enrollment Team, Educating new Enrollees on CDPAS information and forms.</li><li>
Serves as a resource to gather missing EAA forms for Nurse Accepted Enrollments (field pick up).</li></ul><p>
Retention (Assist with Renewal of Members Medicaid eligibility):</p><ul><li>
Responsible for contacting and assisting current senior Health Partners and Complete Care members who are due to recertify their healthcare coverage for Medicaid.</li><li>
Contact Senior Health Partners or Complete Care members two months prior to Medicaid expiration date.</li><li>
Conduct home visits and other appointments as needed to complete the application and obtain all required documentation.</li><li>
Complete Monthly Medicaid renewal applications in a timely, organized fashion.</li><li>
Facilitate compilation of all required documents. Call, write or in person contacts landlords, employers, bankers, insurance companies, etc. to obtain required documents.</li><li>
Submit documentation to Human Resource Administration or Department of Social Services within specified timeframe to assure Medicaid coverage for participant.</li><li>
Monitor Medicaid re-certification time frames for each active Medicaid member.</li><li>
Ensure Human Resource Administration and/or Department of Social Services receives the renewal applications and completes re-certification of eligibility timely.</li><li>
Maintain records on every member to show coverage status and timing of re-certification in TrucareHTML5 by opening assessments 2 months prior to renewal due date and closing them out when a member is fully recertified in ePACES.</li><li>
Prepare/submit monthly reports.</li></ul><p><b>
Other duties:</b></p><ul><li>
Serve as a resource to Care Management Teams, Sales Teams and Nurses for Medicaid and Medicare savings Programs eligibility.</li><li>
Keep up to date on Medicaid and other program issues as well as on changes in Medicaid/Medicare/HMO laws and shares information with other Social Work and Care Team members as appropriate.</li><li>
Participate in relevant entitlement training/meetings.</li><li>
Maintain contact between participant/primary support, business office, social worker, marketing specialists and enrollment specialists to keep parties updated regarding progress of MA and other entitlement applications.</li><li>
Maintain contact between participant/primary support and Medicaid staff of Human Resource Administration as needed.</li><li>
Engage in mastering the Divisions impact on Healthfirst and its Members.</li><li>
Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects.</li><li>
Maintain the highest level of integrity, courtesy, and respect while interacting with clients, employees, and business contacts.</li><li>
Assists with orientation of new Hires so they understand the model, support enrollment growth and can answer routine questions about the program.</li><li>
Successfully meet pre and post training and regulatory exams and audit requirements.</li><li>
Arrive at scheduled work site, team meetings, training sessions and events in accordance to departmental policy.</li><li>
Recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.</li><li>
Handle other duties as assigned with the occasional need to work weekends, additional hours before or after shift schedule and/or from other HF site locations.</li></ul><p><b><br>
Job Qualifications:</b></p><p>
Minimum Qualifications:</p><ul><li>
High school diploma or GED from an accredited institution</li><li>
Member facing or customer service experience</li><li>
Be able to work 9am-5:30pm schedule</li><li>
Be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County.</li></ul><ul><li>
Capability to work in a Hybrid Schedule (remote/office/field)</li><li>
Tech Savvy computer skills such as Microsoft Office Suites: Outlook, Excel, Word, PowerPoint.</li><li>
Bilingual</li><li>
Be able to communicate and engage with the leadership team on virtual platforms such as Zoom or Microsoft Teams chat as well as in person</li></ul><p></p><p><b>
Preferred:</b></p><p>
Associate degree from an accredited institution plus 1 year of related work experience including inbound and outbound call center within a healthcare environment.</p><ul><li><ul><li>
Telephonic experience with frail adult or elderly population.</li><li>
A solid understanding of the value of integrated care.</li><li>
Experience in health insurance, home care environment, acute, sub-acute, long-term care setting, or managed-long term care</li><li>
Have access to a vehicle with valid proof of insurance and be able to travel throughout the 5 boroughs, Westchester, Orange, Sullivan, Rockland, and Nassau County.</li><li>
Experience managing member information or appointments in a shared network environment using paperless database modules</li><li>
Adept at operating within a multi-cultural work environment</li><li>
Bilingual</li></ul>
Prior experience with Medicaid /Medicare Savings Program</li></ul><p></p><p><br>
Hiring Range*:</p><ul><li><p>
Greater New York City Area (NY, NJ, CT residents): $48,600 - $65,960</p></li><li><p>
All Other Locations (within approved locations): $42,200 - $62,400</p></li></ul>
<p>
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.</p>
<p>
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.</p>
<ul><li><i>The hiring range is defined as the lowest and highest salaries that Healthfirst in &ldquo;good faith&rdquo; would pay to a new hire, or for a job promotion, or transfer into this role.</i></li></ul><br>
42200-62400</div>

Entitlement Advocate- Bilingual Spanish or Cantonese/Mandarin

Willow Health

<div><div>In the United States, one in five adults experience a mental health illness and over 12 million people have thoughts of suicide. Mental health crises can be some of the most difficult times in a person&rsquo;s life, and over 17 million people seeking behavioral health care experience a delay in accessing care. Willow Health is on a mission to significantly improve this experience by expanding affordable access to high-quality, evidence-based intensive behavioral health care.</div><div>
In order to make this mission a reality, we are building a virtual crisis care program that provides personalized, recovery-oriented care for people experiencing behavioral health crises.<br>
</div><div></div><br>
<div>Willow Health offers patients immediate access to evidence-based virtual crisis psychotherapy, medication management, certified peer coaching, care management, and around the clock crisis coverage, while working to connect patients to the most appropriate next level of care. Our co-founding team of Cityblock and Oscar alums has two decades of collective experience working in healthcare and healthcare tech, and we are backed by Andreessen Horowitz.</div><div>
As we expand into new markets and grow our provider network, we are seeking a Credentialing &amp; Provider Enrollment Specialist to own and execute the credentialing and payer enrollment process across multiple states and payer types.</div><div></div><div><br>
This role is responsible for ensuring that providers and organizational entities are properly credentialed and enrolled with payers to support timely market launches, uninterrupted care delivery, and compliant billing operations. The specialist will also design and maintain the systems used to track credentialing and enrollment activity as the organization scales.</div>
<h3 class="jobSectionHeader"><b>Day to Day Responsibilities
</b></h3><ul><li>Own the end-to-end credentialing and payer enrollment process for behavioral health providers including psychiatrists, nurse practitioners, therapists, and certified peers across multiple states.</li><li>
Manage internal credentialing onboarding for newly hired providers by collecting and validating required documentation, including licensure, certifications, DEA registration, malpractice insurance, and other credentialing materials.</li><li>
Create and maintain provider directory profiles used across referral and patient access platforms (e.g., Zocdoc and similar directories), ensuring provider biographies, credentials, and practice information are accurate and up to date.</li><li>
Manage provider credentialing and re-credentialing activities, including directly with commercial payers, Medicare (PECOS), Medicaid and through use of other payer portals.</li><li>
Submit and maintain group and facility enrollments, provider roster updates, and location additionals or changes with payers as the organization expands.</li><li>
Ensure timely and accurate completion of provider enrollments, terminations, and roster updates to support billing readiness and payer requirements.</li><li>
Design and maintain credentialing and enrollment tracking systems to monitor application status, renewal timeliness, and enrollment milestones as the company scales.</li><li>
Monitor and manage renewal deadlines for licenses, certifications, liability insurance, and other credentialing requirements to ensure continuous compliance.</li><li>
Maintain organized, accurate, and audit-ready credentialing records and provider files.</li><li>
Serve as the primary internal point of contact for credentialing status updates and collaborate closely with contracting, operations, and revenue cycle teams.</li><li>
Support internal and external credentialing audits and ensure documentation and processes meet regulatory and payer standards.</li><li>
Track credentialing progress to support timely state expansion and provider onboarding.</li></ul><div></div><h3 class="jobSectionHeader"><b><br>
Success in this role will be measured by:</b></h3><ul><li>
Timely completion of provider credentialing and payer enrollments across multiple states.</li><li>
Efficient time-to-credential for new provider hires and state expansion launches.</li><li>
Accurate and well-documented credentialing records with strong audit readiness.</li><li>
Reliable tracking and monitoring processes that prevent credentialing lapses or missed renewal deadlines.</li><li>
Strong cross-team coordination that ensures providers are fully credentialed and ready to deliver billable services.</li></ul><h3 class="jobSectionHeader"><b>
Our ideal candidate has</b></h3><ul><li>
3+ years of experience credentialing for behavioral health across multiple states.</li><li>
Experience managing credentialing and payer enrollment across multiple states and payer types.</li><li>
Hands-on experience with PECOS, Availity, CAQH, and direct payer enrollment portals.</li><li>
Strong understanding of Medicare and Medicaid provider enrollment processes.</li><li>
Exceptional organizational skills and attention to detail.</li><li>
Ability to manage multiple credentialing workflows simultaneously while meeting deadlines.</li><li>
Experience building or improving credentialing tracking systems or operational workflows.</li><li>
Strong written and verbal communication skills with the ability to work cross-functionally across teams.</li><li>
Comfort working independently in a fast-moving and evolving environment.</li><li>
A desire to improve mental health care delivery.</li><li>
An openness to and ability to respond to constructive feedback.</li></ul><h3 class="jobSectionHeader"><b>
Preferred Qualifications</b></h3><ul><li>
CPCS certification or equivalent hands-on credentialing and provider enrollment experience.</li><li>
Experience working in a virtual care or telehealth organization.</li><li>
Experience credentialing behavioral health providers including psychiatrists, nurse practitioners, therapists, and peer specialists.</li><li>
Experience supporting multi-state healthcare organization expansion.</li><li>
Ability to display a professional, positive attitude with strong interpersonal skills and communication skills required and must be able to work independently and collaboratively to meet deadlines.</li><li>
Highly detail-oriented, self-motivated, efficient, and strong organizational skills</li><li>
Excellent written and verbal communication skills</li><li>
Remote experience</li></ul>
<p>
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.</p></div>

Credentialing & Provider Enrollment Specialist

MetroPlusHealth

<div><p><b>Job Ref: </b>TE0087<br>
<b>Category: </b>Finance<br>
<b>Department: </b>FINANCE<br>
<b>Location: </b>50 Water Street, 7th Floor, New York, NY 10004
<br>
<b>Job Type: </b>Temporary<br>
<b>Employment Type: </b>Full-Time<br>
<b>Work Arrangement: </b>Hybrid<br>
<b>Salary Range: </b>$21.00 - $26.00<br>
</p><p></p><p>Empower. Unite. Care.</p>
<p>MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.</p>
<p><b>About NYC Health + Hospitals</b></p>
<p>MetroPlusHealth 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, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.</p>
<p><b>Position Overview</b></p>
<p><b>MetroPlusHealth</b> is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.</p>
<p><b>Duties &amp; Responsibilities</b></p>
<ul><li>Assist in the execution and reconciliation of billing and enrollment processes</li>
<li>Develop and refine standard operating procedures (SOPs) to streamline departmental processes and enhance team efficiency</li>
<li>Provide support in testing and troubleshooting for the new core processing system to ensure optimal functionality</li>
<li>Perform additional duties as assigned</li>
</ul>
<p><b>Work Shifts</b></p>
<p>9:00 AM- 5:00 PM</p>
<p><b>Minimum Qualifications</b></p>
<ul><li>Currently enrolled in an undergraduate program in Business Administration, Finance, Health Administration, or a related field</li>
<li>Experience with database and querying skills highly desirable</li>
</ul>
<p><b>Professional Competencies:</b></p>
<ul><li>Integrity and Trust</li>
<li>Customer Focus</li>
<li>Functional/Technical skills</li>
<li>Written/Oral Communication</li>
</ul>
<p>#LI-Hybrid</p></div><p></p>

Summer Intern - Revenue and Recovery

NYC Health + Hospitals

<div><div><div><h2 class="jobSectionHeader"><b>About NYC Health + Hospitals</b></h2><div><br>
<div><div>
</div><p>MetroPlus<b>Health</b> 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<b>Health</b>'s network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlus<b>Health</b> has been committed to building strong relationships with its members and providers.</p><p></p><p><br>
Empower. Unite. Care.</p><p>
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.</p><p><b>
Position Overview</b></p><p><br>
Under the direction of the Director of Community Outreach, Quality and Compliance, the Senior Quality Analyst position supports the data analysis, monitoring, evaluation, and reporting activities of the Partnership in Care (PIC) department. The analyses they conduct support PIC operations in five key areas: regulatory compliance, care management (including the Advanced Care Management program), quality/performance measurement, special projects/grants, and administrative functions. The role will support the strategic goals of the PIC department to ensure that all MetroPlusHealth HIV- positive members are engaged in care, virally suppressed, and receiving appropriate services. The role requires working knowledge of Microsoft SQL Server, Tableau, and MS Excel.</p><br>
</div></div></div></div><div><div><h2 class="jobSectionHeader"><b>
Work Shifts</b></h2><div><br>
<div><div>
</div><p>9:00 AM - 5:00 PM</p>
</div></div></div></div><div><div><h2 class="jobSectionHeader"><b>
Duties &amp; Responsibilities</b></h2><div></div><div><div><br>
<div>
</div><ul><li><div>Oversees data analysis, evaluation and reporting of HIV SNP&rsquo;s Advanced Care Management (ACM) program activities, ensuring timeliness, completeness and accuracy.</div></li><li><div>
Monitors HIV viral load lab data collection to support viral load suppression quality improvement efforts.</div></li><li><div>
Performs analysis related to SNP audits and compliance activities to ensure adherence with regulatory requirements.</div></li><li><div>
Analyzes SNP recertification and membership data to monitor trends in SNP enrollments and disenrollments.</div></li><li><div>
Designs, plans, and implements of analytical business and technology solutions, i.e., Microsoft SQL Server, Tableau, and MS Excel to support PIC operations, coordinating and collaborating with the IT and Analytics departments as needed.</div></li><li><div>
Analyzes and monitors contractual compliance and business operations to evaluate inefficiencies (e.g., member enrollment, eligibility verification, retention).</div></li><li><div>
Analyzes monthly claims data alongside other data sources (gaps in care, CRG scores, etc.) to create member profiles and acuity scores.</div></li><li><div>
Identifies, prioritizes, and helps distributes members for outreach by PIC staff based on risk and acuity.</div></li><li><div>
Measures and tracks key performance indicators and targets to effectively monitor PIC department activities including ACD line performance, staff productivity and quality outcomes.</div></li><li><div>
Performs extraction, import, and export of data from diverse data sources including various database applications.</div></li><li><div>
Packages data from a variety of reports into a monthly and quarterly PIC departmental dashboard.</div></li><li><div>
Provides training for internal and external staff regarding analyses, reports, or other relevant topics.</div></li><li><div>
Ensures accuracy and conducts validation of all reports and analyses.</div></li><li><div>
Performs statistical analyses to support monitoring and evaluation of PIC department.</div></li><li><div>
Develops and prepares reports, business presentations, and other materials.</div></li><li><div>
Assists with the identification, collection, input, and assembly of documents as required for external and internal audits.</div></li><li><div>
Assists with analysis and reporting for special projects as assigned.</div></li><li><div>
Attends approved in-service and external education and training as per department directives.</div></li></ul>
</div></div></div></div><div><div><h2 class="jobSectionHeader"><b>
Minimum Qualifications</b></h2><div><br>
<div><div>
</div><ul><li><div>Bachelor&rsquo;s degree in Computer Science, Information System, Business Administration, Health Administration, or related field is required.</div></li><li><div>
Minimum of five years of data analysis experience.</div></li><li><div>
Familiarity with analytics/BI reporting tools such as SQL, Tableau, and Power BI.</div></li><li><div>
Advanced working knowledge of Microsoft Office applications including Excel.</div></li><li><div>
Prefer experience in health care industry and knowledge of Managed Care plan operations.</div></li><li><div>
Knowledge of concerns of persons living with HIV/AIDS is preferred.</div></li></ul><div></div><div><b><br>
Professional Competencies</b></div><ul><li><div>
Integrity and Trust</div></li><li><div>
Customer Focus</div></li><li><div>
Displays strong communication, interpersonal, and organizational skills across all levels coupled with effective problem solving, conceptual thinking, quantitative, and analytical skills.</div></li></ul><div>
#LI-Hybrid #MHP50</div></div></div></div></div></div>

Clinical Business Analyst II

Progyny

<div><div>Thank you for considering Progyny!</div><div></div><div>
We&rsquo;re hiring a Solutions Analyst to be the operational lead for our external eligibility and enrollment vendor integration. You&rsquo;ll be the day‑to‑day point of contact for the vendor, own file/data workflows from intake to resolution, and stand up scalable processes for exception handling, reconciliations, and change requests. You&rsquo;ll help build and manage new workflows to support peak enrollment and ongoing operations. This is a hands‑on, detail‑oriented role for someone who loves connecting business needs to technical systems, diving into files, finding root causes fast, and getting cross‑functional partners (internal and external) aligned on a clear fix.</div><div></div><div>
What you&rsquo;ll do...</div><ul><li><div>
Systems &amp; Vendor Integration:</div><ul><li><div>
Serve as the primary operational POC to our enrollment/eligibility vendor&mdash;triage issues, drive SLAs, and maintain clean communication loops.</div></li><li><div>
Lead day‑to‑day file exchange operations: monitor inbound/outbound files, validate formats, track acknowledgements, and ensure data integrity across platforms.</div></li></ul></li><li><div>
Analysis, Exceptions &amp; Reconciliations</div><ul><li><div>
Review and analyze enrollment eligibility data (e.g., JSON/CSV flat files); perform root‑cause analysis on exceptions and data mismatches.</div></li><li><div>
File, track, and resolve issues in vendor and internal ticketing systems; document resolution paths and preventative measures.</div></li><li><div>
Run manual enrollment keying when needed and manage manual term and premium/billing reconciliations between systems.</div></li></ul></li><li><div>
Process, Documentation &amp; Testing</div><ul><li><div>
Author playbooks, SOPs, and other resources for exceptions, reconciliations, and go‑forward maintenance.</div></li></ul></li><li><div>
Stakeholder &amp; Change Management</div><ul><li><div>
Partner with Product, Engineering/IT, Finance/Billing and Client Solutions on group profile updates, new implementations, and change requests.</div></li></ul></li></ul><div>
About you&hellip;</div><ul><li><div>
Bachelor&rsquo;s degree in Business Administration, Industrial Engineering, Information Systems, Computer Science, Data Analytics, or a related field.</div></li><li><div>
3-5 years in insurance or benefits operations, systems/business analysis, or vendor integrations with direct experience in eligibility and enrollment to billing data flows.</div></li><li><div>
Hands‑on experience with data files, integrations and error handling.</div></li><li><div>
Demonstrated root‑cause analysis skills and an ability to translate technical findings into clear action plans for non‑technical stakeholders.</div></li><li><div>
Strong Excel (lookups, pivots), comfort with large datasets; familiarity with SQL for ad‑hoc validation is a plus. Salesforce knowledge preferred.</div></li><li><div>
Proven stakeholder management with external vendors and cross‑functional teams; calm under pressure, excellent written and verbal communication.</div></li><li><div>
Process mindset: can document workflows, design controls, and drive continuous improvement.</div></li><li><div>
Self-starter who takes initiative, works independently, and thrives in a fast-paced, constantly changing environment</div></li><li><div>
Able to work a hybrid schedule of 3 days/week in our NYC office</div></li></ul><div></div><div>
Please note: This is not a digital nomad or remote international position; candidates must be based in the United States. Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future.</div><div></div><div>
About Progyny:</div><div>
Progyny (Nasdaq: PGNY) is a global leader in women&rsquo;s health and family building solutions, trusted by the nation&rsquo;s leading employers, health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians.</div><div></div><div>
Our benefits solution empowers patients with concierge support, coaching, education, and digital tools; provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.</div><div></div><div>
Our mission is to empower healthier, supported journeys through transformative fertility, family building and women&rsquo;s health benefits.</div><div></div><div>
Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit <div>www.progyny.com</div>.</div><div></div><div>
Our perks:</div><ul><li><div>
Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents&rsquo; Employee Affiliation Group</div></li><li><div>
Menopause and midlife care</div></li></ul><ul><li><div>
Health, dental, vision and life insurance options for employees and family</div></li></ul><ul><li><div>
Free in-person, virtual and text-based mental health and wellness support</div></li></ul><ul><li><div>
Paid time off, including vacation, sick leave, personal days and summer flex time</div></li></ul><ul><li><div>
Company equity</div></li></ul><ul><li><div>
Bonus program</div></li></ul><ul><li><div>
401(k) plan with company match</div></li></ul><ul><li><div>
Access to on-demand legal and financial advice</div></li><li><div>
Learning and development programs to help you grow professionally and a mentorship program</div></li></ul><ul><li><div>
Company social events to include annual volunteer day and donation matching</div></li></ul><ul><li><div>
Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office</div></li></ul><div></div><div>
In compliance with New York City's Wage Transparency Law, the annual salary [wage] range for NYC-based applicants is: $80,000 - $95,000. There are a variety of factors that go into determining a salary range, including but not limited to external market benchmark data, geographic location, and years of experience sought/required. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity.</div><div></div><div>
Progyny is proud to be an Equal Opportunity and Affirmative Action employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, skills and experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, marital status, pregnancy or related condition, status as a protected veteran, criminal history consistent with legal requirements or any other basis protected by law.</div><div></div><div>
If you are an individual with a disability and need assistance or an accommodation during the recruiting process, please send an e-mail to <div>apply@progyny.com</div>.</div><div>
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Eligibility Operations Solutions Analyst

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