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Director of Employee Healthcare Strategy

Job Details

Location:
New York, NY 10001

Category:
Leadership

Type:
Full Time

Title: Director of Employee Healthcare Strategy

Location: DocGo HQ, 35 West 35th Street, New York, NY 10001 

Employment Type: Full time

Benefits: Medical, Dental, and Vision (with company contribution), Paid Time Off, 401k

About DocGo:

DocGo is transforming healthcare with peerless innovation and on-the-ground care.  Our mobile workforce of thousands of full-time traveling clinicians and our proprietary, AI-powered software leverages robust medical record integrations to drastically improve patient outcomes. In our tireless pursuit of high-quality, highly affordable healthcare for all, DocGo makes the impossible possible. We’re revolutionizing the delivery of healthcare and we need an Director of Employee Healthcare Strategy  to join us!

About The Job:

Responsible for the timely and accurate adjudication of all claims for DocGo products. Reviews and resolves pended and corrected claims. Analyzes claim resubmissions to determine areas for provider education or system re-configuration. Serve as the primary point of contact for claim issues raised by Providers and internal DocGo departments. Provides feedback on department workflows and identifies opportunities for redesign. Performs claims testing to ensure that systems are designed efficiently based on the Plan’s benefit structure.

Responsibilities: 

  • Review, research and finalize provider claims within established regulatory requirements and DocGo Company policies

  • Analyze provider issues and collaborate with other departments to resolve. Identifies and documents opportunities for provider education

  • Review provider disputes or appeals and provide a detailed analysis of findings

  • Conduct claim testing for DocGo Company products

  • Review claim processing results of Delegated Vendors

  • Provides expertise and assistance relative to provider billing and payment guidelines consistent with ABC Company policies and procedures and State or CMS guidelines

  • Document all provider contacts; including telephonically, emails, written correspondence

  • Trouble shoot and identify root cause of problems and participate in developing solutions

  • Provides follow up and intervention relating to provider claim inquiries

  • Collaborate with internal teams and departments to ensure applications are processed, contracts are executed and all providers are credentialed in a timely manner.

  • Participates in standing meetings as necessary, including but not limited to provider relations, contracting, network development, team building, etc.

  • Performs other duties and special projects as assigned and directed


 

Required Qualifications:

  • BA/BS degree in a financial field or equivalent healthcare experience

  • 3+ years of claim processing experience, preferably in a Medicaid/Medicare, MLTC environment, Customer Service in health insurance product environment.

  • Use of Microsoft Access or similar query tool. Proficiency with MS applications, including but not limited to Word, Excel, Outlook, Power Point, Project

  • Strong telephonic and customer service skills


 

Preferred Qualifications:

  • Effective presentation skills

  • Excellent verbal and written communication skills

  • Must be able to participate in meetings with all levels of management within the organization

  • Detail oriented, excellent follow up

  • Ability to multitask in a fast paced environment

  • Must be service oriented, quick learner, team player

  • Appreciation of cultural diversity and sensitivity toward target population

EEO/AAP Statement:  DocGo is an equal opportunity employer. We acknowledge and honor the fundamental value and dignity of all individuals. We pledge ourselves to crafting and maintaining an environment that respects diverse traditions, heritages, and experiences.  DocGo is an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

The above-noted job description is not intended to describe, in detail, the multitude of tasks that may be assigned but rather to give the applicant a general sense of the responsibilities and expectations of this position.  As the nature of business demands change so, too, may the essential functions of the position. 

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