MVP Health Care is one of the fastest growing health benefits companies in the Northeast.  We offer a great work environment, excellent benefits, and the opportunity to join a leading edge organization

Under the Direction of the Utilization Management Supervisor: Performs DRG Validation submitted by hospitals/facilities for all regions, which have contractual agreements with MVP for case rate/ DRG payment methodology.  Utilizes ICD-9-CM Coding Guidelines to determine correct order of coding and validate sequencing of coding using the HSS DRG Grouper.  Discuss complex cases with the UM Supervisor, Manager and Medical Directors.  Assists with the coordination of the monthly UM DRG retrospective reports.  Knows and interprets MVP contracts, policies and procedures, InterQual Criteria and coding conventions. Researches, coordinates, and completes special projects for the UM Supervisor. Recommends revisions in the UM process to ensure the maximum level of automation, efficient time utilization and data quality.  Completes other duties regarding UM/Health Services functions as assigned by the UM Supervisor or Manager.

Minimum Education:   

BS in health management or administration is preferred. RHIT, CCS, CPC CPC-H preferred.

Minimum Experience:  

3+ years strong clinical background with a minimum of 1 year UM experience preferred.

Required Skills:

·         Proven success with interacting with providers on delicate matters of medical necessity and service appropriateness.

·         Demonstrated problem-solving skills with excellent verbal and written communication abilities.

·         Familiarity with Diagnoses and Procedural Coding Practices required.

·         Independent thought process; oriented toward probing/case coordination.

·         Strong PC skills.

·         Able to manage multiple tasks in a fast-paced environment.

·         Excellent verbal and written communication skills.

MVP Health Care is an NCQA accredited health plan.  MVP offers a competitive salary and health benefit package.  For consideration apply online at www.mvphealthcare.com/jobs