Professional, Member Ops Billing Specialist

• Growth opportunities to uplevel your career

• A people-centric culture embracing and celebrating diverse perspectives backgrounds and experiences within our team

• Competitive compensation and comprehensive benefits focused on well-being

• An 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.

Youll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation humility to collaborate as a team and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier more vibrant communities.

About the Opportunity

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. Provide direction related to billing cash application collections and account reconciliations for designated business categories including New York State of Health populations (e.g. Child Health Plus Essential Plan On Exchange/Qualified Health Plans) commercial populations and other government programs populations. Ensure compliance with government regulations and participate as a critical resource in the development implementation communication and maintenance of A/R operating policies and procedures ensuring sufficient internal controls are in place. The professional will have significant understanding of the applicable processes and systems.

What Youll Do

• Lead audits such as DOH SOC and Model Audit Rule (MAR)

• 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

• Other duties as assigned by leadership

Skills and Experience

• Education Licensures & Certifications

  • Bachelors degree in Business Information Systems or related field required

• Years of Experience (Required & Preferred)

  • 3-5 years of experience in healthcare operations billing financial or customer service role required

  • 1-2 years of experience working with Information Technology or automation projects

• Required Job 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

• Preferred Job Skills

  • Knowledge of healthcare compliance and audit standards

  • Hands-on experience with AI preferred

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.

We do not request current or historical salary information from candidates.

MVPs Inclusion Statement

At MVP Health Care we believe creating healthier communities begins with nurturing a healthy workplace. As an organization we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger and our unique perspectives are catalysts for creativity and collaboration.

MVP is an equal opportunity employer and recruits employs trains compensates and promotes without discrimination based on race color creed national origin citizenship ethnicity ancestry sex gender identity gender expression religion age marital status personal appearance sexual orientation family responsibilities familial status physical or mental disability handicapping condition medical condition pregnancy status predisposing genetic characteristics or information domestic violence victim status political affiliation military or veteran status Vietnam-era or special disabled Veteran or other legally protected classifications.

To support a safe drug-free workplace pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability please contact our Talent team at.