CDPHP

Job Description: Summary: The IT Platform Administrator acts as a liaison between the business and technical resources by ensuring the availability and successful operation of applications for users. This individual will demonstrate a high-level of responsibility and consistency by timely monitoring, responding, and troubleshooting of incidents, installing, upgrading, and maintaining application currency. This position will work to identify functionality to empower users through self-service and automation of relevant tasks. In addition to operating as application support, the IT Platform Administrator will perform periodic audits and maintain application compliance. The Administrator also frequently interacts with multiple departments to advocate for stakeholders' and platform best interests. Essential Accountabilities: Level I •\tInstalls, configures, troubleshoots, patches, and maintains enterprise software platforms for applications to achieve reliable, highly...

Job Description: This position is onsite/in-person at the CDPHP Corporate Woods office ( 11 Corporate Woods, Albany, NY 1221) Shift/Schedule: Monday - Friday - 7:30AM - 4PM Summary: The Mailing and Warehouse Associate, Mailing & Receiving Services will be responsible for all loading dock operations and the completion of the necessary activities related to the processing of incoming and outgoing mail for the entire organization. This includes loading and unloading trucks, preparing outgoing materials and maintaining a safe, clean environment. The candidate will also serve as a backup to all mailroom services. The Mailing and Warehouse Associate, Mailing & Receiving Services is responsible to ensure compliance with all CDPHP's departmental objectives, including state & federally mandated processing timelines. Additionally, compliance with federal postal regulations is required. Essential Accountabilities: Accurate & timely processing of company-wide...

Job Description: Summary: Based on the scope of the role & business needs, we're exclusively seeking candidates who reside in Albany/Capital Region. The Business Consultant serves as a strategic partner between the Health Plan and its internal and external clients, leveraging data-driven insights to guide decision-making and improve healthcare outcomes. This role fosters a multidisciplinary approach by collaborating across departments including Sales, Pharmacy, Medical Services and Workplace Wellness to create a centralized reporting function. The consultant translates complex data into actionable recommendations that drive cost savings, enhance quality, and support organizational goals. Essential Accountabilities: Level I Analyze enterprise-wide trends and present insights to senior leadership and internal and external clients to inform strategic decisions. Serve as the primary point of contact for consulting engagements, ensuring alignment with internal and...

Job Description: Summary: The Reception Specialist will be responsible for providing a positive and efficient experience for all patients of the practice facility. This includes welcoming patients and assisting with checking in/out for appointments, verifying/updating patient and insurer information, scheduling, and assisting with payments as necessary. The Reception Specialist will also seek to provide excellent internal customer service, assisting each practice office with questions and follow up as needed. This is an Onsite position : 1785 Building 1785, Rt 9. Clifton Park, NY. Essential Accountabilities: Welcome and greet patients upon entering the facility. Obtain and/or update patient information, including personal/demographic data, and insurance information. Ensures all required information is on file and up to date, or completed by the patient as part of check in procedures. Complete patient related data entry for each practice, at times using multiple...

Job Description: Summary: The Healthcare Statistical Analyst performs technical services within the actuarial or risk adjustment department that support of the Health Plans operations which monitors and maintains financial solvency through the understanding of current data & environment and modeling of future events. This role interacts with internal and external partners and Regulatory agencies. This role monitors trends, bring forward opportunities and insights found in the data to the applicable audiences. This position supports leadership by providing statistical information and analysis needed to make informed decisions, identifies trends, and utilizes data mining techniques and development of advanced predictive models. Essential Accountabilities: All Levels Updates existing and aids in the creation of new analysis pertaining to benefit designs, claims experience, Value Based Payment (VBP) programs and valuation of internal and externally led claims savings...

Job Description: Summary: The Manager of Credentialing Operations has direct responsibility for managing the internal operational credentialing activities for the Health Plan. The Manager oversees the end-to-end credentialing process for healthcare providers in compliance with regulatory, accreditation, and organizational standards. This role manages daily operations, leads credentialing staff, and ensures timely verification, enrollment, and maintenance of provider credentials. They are responsible for monitoring performance metrics, enforcing quality standards, and driving process improvements to increase efficiency and ensure accuracy in provider data systems. Essential Accountabilities: Accomplishes defined objectives and oversees all activities which relate to provider credentialing through effective planning, organization and utilization of personnel and equipment. Develops and implements department goals and corresponding action plans and monitors performance...

Job Description: Summary: Responsible for managing and providing divisional support to all Medical Records Unit (MRU) activities such as medical record requests, receipts, research and tracking through the medical record database. Research Facets, Plan Connexion processing system and control workflow to ensure intakes are handled timely by the appropriate area, including BlueCard and Local claims, to ensure performance metrics are met. Essential Accountabilities: Level I •\tResponsible for the quality assurance of all internal and external medical record requests and the determination of appropriate outgoing communication. •\tReview medical record receipts including unsolicited medical records for completeness and determine appropriate workflow. •\tInterface with and extract data from the Facets and/or Plan Connexion processing systems to prepare and complete medical record reports. •\tProcess and maintain current and accurate Department of Labor medical record requests....

Job Description: Summary: Under the direction of the Assigned Management, upon successful completion of all phases of training, and in accordance with established HIPAA regulations the Enrollment Specialist performs enrollment core processing and servicing in accordance with the Health Plan Operation's enrollment regulations, Underwriting Guidelines and applicable government regulations. The focus of this role is to ensure prompt, accurate, and efficient servicing of all broker, member and group administrator inquiries for all product lines. Inquiries are received by the following but not limited to; telephone, email, written inquiries, lobby walk-in customers and through on-site visits with an employer group. The B version of this role will require the individual to be on the phone regularly. Essential Primary Responsibilities/Accountabilities: Level I: Responsible for Government Programs, Small, Mid, and Large Employer Group Subscriber Enrollment Operations. Responsible...

Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation, and/or inpatient coding and has a high level of understanding of the current MS-DRG, and APR-DRG payment systems. This position is responsible for reviewing medical records for appropriate provider documentation to support the principal diagnosis, co-morbidities, complications, secondary diagnosis, surgical procedures, POA indicators to validate coding and DRG assignment accuracy, insuring the physician documentation supports the hospital coded data. Essential Accountabilities: Level I • Analyzes and audits acute inpatient claims. Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise. Clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently....

Job Description: Summary: The Business Systems Analyst is a critical role in the delivery of products for Lifetime Healthcare Companies. This position collaborates with stakeholders throughout the organization to understand business objectives and defines IT system requirements and specifications for the implementation of IT system solutions. The Business Systems Analyst will serve as the primary interface between the business and IT teams to gather, document and analyze all level of requirements with the emphasis on delivering functional and non-functional requirements to solution architects and IT teams. Business Systems Analyst, in collaboration, with their stakeholders sets scope for work items. Essential Accountabilities: All Levels: Collaborates with all stakeholders to elicit, analyze, specify, and gather business, stakeholder, and solution requirements. This will include assisting and/or contributing to the creation of documented requirements leveraging the...

Job Description: Based on business needs, we're exclusively seeking candidates who reside in Albany, NY / Capital Region area. Summary: The Medicare Sales Advocate (MSA) is responsible for finding Medicare solutions for beneficiaries by explaining CDPHP's Medicare benefits and plans to prospective members along with assisting CDPHP Medicare Authorized Agents. This position will also qualify prospective members and arrange for enrollment meetings with a CDPHP Authorized Sales Agent. The MSA duties also include resolving eligibility and enrollment related questions and responding to internal and external customer inquiries that may be received via email or by phone. This position requires the ability to work a flexible schedule to ensure all Medicare regulations are met. Essential Accountabilities: Responsible for accurately explaining CDPHP Medicare products to beneficiaries Required to meet sales and retention goals as determined by Management Responsible for...

Job Description: Summary: The Finance Data Management Team is responsible for supporting the Finance division in several main capacities: management of the Workday Foundation Data Model and Workday Finance Business Processes, administration and development of Workday Accounting Center, administration of Workday Adaptive Planning, maintenance of Workday Finance configurations, and data management in support of reporting, integrations, audits and compliance. This role provides maintenance and administration of finance specific applications, data and business processes which provide support across the Finance division. A Financial Data Consultant collaborates cross-functionally throughout the organization to ensure the quality and timeliness of our financial transactions, reporting and analysis. Essential Accountabilities: Level I • Participates in administration and configuration across all finance technologies supported by the Finance Data Management team which include...

Job Description: Summary: The Business Systems Analyst is a critical role in the delivery of products for Lifetime Healthcare Companies. This position collaborates with stakeholders throughout the organization to understand business objectives and defines IT system requirements and specifications for the implementation of IT system solutions. The Business Systems Analyst will serve as the primary interface between the business and IT teams to gather, document and analyze all level of requirements with the emphasis on delivering functional and non-functional requirements to solution architects and IT teams. Business Systems Analyst, in collaboration, with their stakeholders sets scope for work items. Essential Accountabilities: All Levels: Collaborates with all stakeholders to elicit, analyze, specify, and gather business, stakeholder, and solution requirements. This will include assisting and/or contributing to the creation of documented requirements leveraging the...

Job Description: Summary: This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources and assists with navigating resources available and provide assistance with addressing SDoH barriers and care gaps. This position educates and assists with the enrollment and recertification process for Marketplace Facilitated Enrollment (MFE): On and Off Marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market - Qualified Health Plan (QHP). This position requires working occasional evenings and weekends for outreach and community events. Essential Accountabilities: Level I • Educates Medicaid, Medicare, and Commercial members on healthcare benefits, and community...

Job Description: Summary: The FSA/HRA Plan Administrator responds to and resolves written, telephone, and personal inquiries from subscribers, groups, and providers concerning all departmental products, policies, and procedures in a professional and efficient manner. This position coordinates and monitors daily administrative activities regarding departmental products to ensure established standards and deadlines are met. Departmental Product Portfolio: Flexible Spending Accounts (FSA), Health Reimbursement Arrangements (HRA), Health Savings Accounts (HSA), Transit and Parking, Student Loan, Tuition Reimbursement and Wellness Benefits. Essential Accountabilities: Level I Responds to all inquiries from an internal and external perspective completely, accurately, and timely and in a professional and efficient manner. Supports customer service team in researching member inquiries. Researches claims and determines claim eligibility in accordance with IRS regulations....

Job Description: Summary: The Manager of Data Platform Administration plans, directs, and evaluates the work of Data Platform Administration team in the planning, design, development and maintenance of new and existing applications and data systems. This position communicates with users to develop and maintain a firsthand knowledge of their plans, operations, problems, and opportunities. This position also champions the development, enforcement and refinement of standards for use, control, performance, updating and maintenance in conjunction with Data Platform Administration. This role reviews in-progress and completed work for completeness, quality, and adherence to standards. Essential Accountabilities: •\tPlans, directs and controls the activities of the analysis, design, development, and installation phases of the systems lifecycle. •\tReviews service requests / projects and consults with executive sponsors, requesters, and/or user representatives to clarify intent,...

Job Description: Summary: The Business Coordinator supports the Government Programs (GP) line of business, organization, strategy, goals, and objectives to achieve required line of business (LOB) performance. This includes our SafetyNet (Medicaid, Child Health Plus-CHP), Essential Plan (EP) and HARP, along with Medicare, DUALS and Individual Market products. This position is engaged in all facets of the GP business and organization to support effective and efficient performance across the entire organization to deliver on goals and objectives. The GP Business Coordinator may often provide administrative support to the Government Programs leadership and full team as needed. Essential Accountabilities: Works directly with the Government Programs leadership regarding assigned GP business endeavors. Leads and coordinates special projects or tasks for leadership as necessary. Supports leadership in educating employees on company and business policies, practices, and procedures....

Job Description: Summary: This position supports the workflow of the Medical Services division. The Medical Services Coordination Specialist provides support for any of the programs of Behavioral Health, Quality Management, or Member Care Management. This position is responsible for adhering to certain regulatory requirements as well helping to support and connect members to appropriate internal Health Plan resources, Clinical Case Management team and external community support systems. Essential Accountabilities: Level I Review and prep clinical case for clinical staff. Assesses member's needs by applying Health Plan approved case management guidelines and assessment tools. Makes appropriate referrals to clinical programs. Collaborates with the clinical care team to support enrollees. Works with enrollee/caregiver/legal guardian to identify and achieve shared treatment goals. Manages a caseload productively and keeps appropriate documentation according to health...

Job Description: *Based on the scope of the role, onsite/in-person expectations and business needs, we're exclusively seeking candidates who reside in Albany, NY / Capital Region. Summary: Level II: The Sales Executive II is an intermediate or mid-level sales position with the CDPHP Commercial Growth department applying acquired sales skills, exercising judgement within defined guidelines and practices to determine appropriate action. The Sales Executive II will be responsible for identifying, lead generating and conversion of prospective clients with varying complexity. The Sales Executive II will be responsible for preparing and executing a sales strategy as approved by the Director. The Sales Executive II will be responsible for developing and delivering presentations to brokers, prospective clients, members, and other key stakeholders educating them about products and programming. The Sales Executive II will be responsible for consulting with key stakeholders in the...

Job Description: This position is responsible for coordinating, integrating, and monitoring the utilization of behavioral health (BH) or physical health (PH) services for members, ensuring compliance with internal and external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as required, to meet departmental time frames. Per department needs, may be responsible for additional hours. Essential Accountabilities: Level I Performs pre-service, concurrent and post-service clinical reviews to determine the appropriateness of services requested for the diagnosis and treatment of members' behavioral health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical review...