Careers

Quality Health Plans of New York, Inc. (“QHPNY”) is a Medicare Advantage HMO committed to providing our members the highest caliber, most effective and innovative programs in the healthcare industry.careers1

QHPNY is focused on providing quality, affordable, convenient, and easy-to-use healthcare for all of our members.

Employees receive personal job satisfaction and purpose while working with QHPNY, as well as competitive compensation and employee benefits which consist of:

  • Medical – QHPNY pays a portion of the coverage
  • Dental and Vision Coverage
  • Life Insurance
  • Short Term and Long Term Disability
  • 401(k) Retirement Plan inclusive of Company Match
  • Paid Time Off
  • Career Path Opportunities

We will list career openings as they occur below; however, we always accept resumes via e-mail in consideration for future openings. Please send your resume embedded in the body of the message in plain text format. Attachments will NOT be opened.

Openings

Medicare Claims Adjudicator

 Responsibilities:

  • Adjudicate Medicare claims and take appropriate actions to resolve discrepancies.
  • Work backlog of denied/rejected claims for timely resubmission.
  • Manage assigned queues keeping up to date and current on all claims and meeting productivity criteria.
  • Obtain necessary documentation and provide to claims supervisor upon their request for billing and audit purposes
  • Follow all applicable Medicare and NYS regulations including HIPAA
  • Must adhere to claim turn around times
  • Work any provider or member claim issues for resolution
  • Communications with providers for claim issue resolution
  • Ability to multitask while maintaining attention to detail.
  • Ability to work efficiently and calmly in an environment with changing priorities
  • Detail oriented with efficient time management and strong communication skills

Key Competencies:

  • Takes initiative; plans work and carries out tasks without detailed instructions.
  • Thoroughness, ensuring that one’s own and other’s work and information are complete and accurate.
  • Customer focus; ability to connect with our members to build engagement and trust.
  • Accountability: Takes responsibility for achieving results and meets the expectations that have been set forth.
  • Interpersonal awareness: effectively listens to members and ability to notice and interpret others concerns and feelings and ability to communicate with respect.
  • Professional demeanor; always acts in a professional manner with members.
  • Cultural Sensitivity; ability to work effectively with all races, nationalities, cultures, disabilities, ages, and sexes.

Qualifications:

  • Must have a minimum of 5 year Medicare claims adjudication experience.
  • Medicare Advantage experience required
  • Must be knowledgeable ICD9, ICD10. CPT, Medicare Fee schedule, APC rates, Modifiers, HICFA1500, UB04
  • EDI processing experience required.
  • Ability to multi-task, good organizational and time management skills
  • Basic understanding of Managed Care HMO Health Insurance (preferred)

For an opportunity to join the QHPNY team please submit your resume and salary requirements via the link above.

Pharmacy Tech

Pharmacy Tech Responsibilities:

  • Process prior authorization and pharmacy operational paperwork.
  • Review and audit pharmacy data, including Prescription claims.
  • Compliance with Plan and HIPPA confidentiality regulations
  • Professionally handle all incoming member and provider phone calls
  • Enter required documentation into the system pertaining to each call
  • Places out-bound calls to assist with follow-up requirements
  • Assist with additional pharmacy duties, reports and projects as assigned.
  • Connects and coordinates information to non-English callers with a 3rd party translation service
  • Additional requirements as assigned.

Qualifications:

  • Current Florida Pharmacy Technician License (RPhT).
  • Current National Certified Pharmacy Technician Certification (CPhT).
  • Graduate from an accredited training program preferred.
  • Available for different shifts during office hours Monday – Sunday from 8 a.m. – 8 p.m.
  • Bi-Lingual English/Spanish preferred but not required
  • Knowledge of drug names and generic equivalents a plus.
  • Must be flexible and understanding of change and works well with others.
  • Able to trouble-shoot callers requests and concerns and affectively listen to requests
  • Excellent customer service skills.
  • 2 years experience in Managed Care preferred.
  • Detail oriented , able to multi task.
  • Excellent computer skills. Must know Excel and MS Word.

For an opportunity to join the QHPNY team please submit your resume and salary requirements via the link above.

Customer Service Specialist

Responsibilities:

  • Professionally handle all inbound Member and Provider phone calls
  • Assess all in-bound calls accurately & efficiently to address caller’s needs
  • Resolve issues for Member and Provider by researching documentation, system information or gaining knowledge from other staff, Management and departments
  • Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified
  • Assists in the orientation of new members and in the re-education of existing members regarding health plan procedures
  • Logs, tracks and appropriately documents all issues utilizing on-line systems and procedures, and in accordance with all applicable guidelines and requirements
  • Demonstrates based behaviors such as initiative, accountability and value
  • Places out-bound calls to assist with follow-up requirements
  • Recommend department enhancements when applicable
  • Connect and coordinate information to non-English callers with a 3rd party translation service
  • Additional duties and projects as required

Qualifications:

  •  Must have a minimum of 1 year Customer Service Experience in a high volume inbound Call Center
  • Excellent Communication Skills and Interpersonal Skills
  • Bi-Lingual English/Spanish (preferred but not required)
  • Must be Computer literate and type 35/wpm required
  • Ability to multi-task, good organizational and time management skills
  • Ability to effectively present information and respond to questions from members
  • Basic understanding of Managed Care HMO Health Insurance (preferred)
  • Ability to read, analyze, and interpret verbal and written instructions
  • Ability to act on feedback provided by showing ownership of his/her own development
  • Available for different shifts during office hours Monday – Sunday from 8 a.m. – 8 p.m. Able to work Sat. and Sun. 8am – 8pm and Mon.-Fri. from 5pm – 8pm
  • Able to trouble-shoot callers requests and concerns and effectively listen to requests
  • Must be reliable and flexible due to the schedule requirements

 

For an opportunity to join the QHPNY team please submit your resume and salary requirements via the link above.

Marketing Assistant – Intern

Responsibilities:

Are you a student looking to gain experience within the Marketing aspects of a Medicare health insurance company? Quality Health Plans of New York has an exciting internship opportunity that offers exposure and the option to learn many aspects of the Marketing process.

 

About Quality Health Plans of New York, Inc.:
Quality Health Plans of New York, Inc. (“QHPNY”) is a Medicare Advantage HMO committed to providing our members the highest caliber, most effective and innovative programs in the healthcare industry.

The QHPNY Medicare Advantage Plans offer coverage in Nassau, Suffolk, Queens, and Richmond Counties.

We are currently looking for energetic applicants that would like to learn and assist QHPNY with tasks such as:

  • Preparing for marketing sales events – gathering product information to be passed out & used during presentation events
  • .Prepare items to be mailed to different Marketing Agencies
  • Create/update inventory reports
  • Assist with office requirements consisting of filing, scanning, and phones

Qualifications:

  • Eager student that is studying marketing & wants to learn more about the Healthcare industry
  • Organized and extremely detail oriented.
  • Excellent computer skills & communication skills
  • Strong work ethic to meet changes in responsibilities that will take place daily
  • Ability to maintain a professional demeanor at all times.
  • Understand & adhere to the confidential requirements of QHPNY

We are offering full time & part time opportunities and will work around school schedules. Internship hourly rate will be $9.00.

For an opportunity to join the QHPNY team please apply online. via the link above.

 Medicare Sales Marketing Agent- In house

Responsibilities:

  • Conduct in-person appointments and group Educational and Seminar Sales events.
  • Develop and maintain strong relationships with physicians, community leaders, and potential enrollees.
  • Prospect and identify new site development opportunities that will generate enrollments.
  • Responsible for meeting enrollment goals while adhering to all CMS and QHPNY marketing regulations.
  • Accurately complete and submit enrollment applications and accompanying paperwork within required time period.

Qualifications:

  • Active NYS Health License
  • Minimum of two years Medicare Sales Experience
  • Strong communication and presentation skills
  • Ensure that members’ information remains confidential at all times.
  • Bilingual skills a plus – Cantonese, Mandarin or Spanish

For an opportunity to join the QHPNY team please submit your resume and salary requirements via the link above.