Professional, Member Ops Billing Specialist

Join Us in Shaping the Future of Health Care At MVP Health Care, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What’s in it for you: 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. You’ll 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 You’ll 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 Bachelor's 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. $51,395.00-$68,354.75 MVP's 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 View email address on click.appcast.io. At MVP Health Care, we’re more than a health insurance company—we’re a mission-driven organization committed to creating a healthier future for all. We believe in the power of innovation, collaboration, and continuous improvement to drive meaningful change.