Systems Software Programmer / Business Process Specialist
Integrated Resources, New York, NY, United States
Job Title:
Systems Software Programmer / Business Process Specialist
Location:
New York, NY 10004
Duration:
04/27/2026 - 06/20/2026
Shift:
9:00 AM - 5:00 PM
Schedule:
5 days/week, 7 hrs/day, 35 hrs/week, No on-call
Schedule Notes:
Full time; Monday-Friday; 35 hrs/week; Hybrid; Non-patient facing
Work Setting:
Managed Care / Health Plan
Pay Range: $65-$70/hr.
Position Overview
This position supports the successful migration to the Health Edge / Health Rules Payer (HRP) core system for Provider Network Operations (PNO). The role participates in cross-functional and multi-departmental workgroups, representing PNO priorities and workflows throughout system deployment.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care, with a mission that healthcare is a right, not a privilege.
Key Responsibilities
Support migration to Health Rules Payer (HRP) core claims system for Provider Network Operations
Participate in all phases of HRP rollout including preparation, testing, and post go-live activities
Maintain PNO issue tracker and support issue resolution impacting providers
Update process documentation, policies, and procedures related to HRP and PNO operations
Prepare executive summaries and communication materials related to HRP updates
Represent PNO leadership in operational and HRP-related meetings
Support additional critical PNO projects as needed
Perform provider data quality assurance across CACTUS, PowerStepp, HRP, and Salesforce systems
Monitor and triage provider complaints related to HRP migration
Perform data collection, extraction, analysis, and reporting related to HRP migration and PNO operations
Act as liaison between Credentialing, Provider Maintenance, and Customer Service teams
Investigate and respond to interdepartmental inquiries related to HRP and PNO processes
Perform additional duties as assigned
Required Skills & Experience
Cross-functional coordination and stakeholder management
Project coordination and operational support
Experience with provider data systems (CACTUS, PowerStepp, Salesforce)
Experience supporting system migrations (HRP/HealthEdge preferred)
Strong analytical skills including data collection, extraction, and reporting
Knowledge of provider network operations and healthcare systems
Understanding of provider hierarchy, contracts, Medicare fee schedules, CPT/HCPCS codes
General understanding of claims adjudication processes
Ability to manage multiple priorities and meet deadlines
Strong written and verbal communication skills
Ability to work independently and in a fast-paced environment
Strong proficiency in Microsoft Office tools
Education & Experience
Bachelor's degree required
3-5 years of experience in a health plan environment (Medicaid experience preferred)
Equivalent combination of education and experience accepted
Certifications & Licensure
None
Professional Competencies
Integrity and Trust
Customer Focus
Detail-oriented, organized, and dependable
Strong problem-solving and analytical abilities
Ability to manage workload independently and escalate issues appropriately
Ability to prepare reports and deliver presentations
Ability to interpret data and provide actionable recommendations
Ability to prioritize and work in a dynamic environment
Systems Software Programmer / Business Process Specialist
Location:
New York, NY 10004
Duration:
04/27/2026 - 06/20/2026
Shift:
9:00 AM - 5:00 PM
Schedule:
5 days/week, 7 hrs/day, 35 hrs/week, No on-call
Schedule Notes:
Full time; Monday-Friday; 35 hrs/week; Hybrid; Non-patient facing
Work Setting:
Managed Care / Health Plan
Pay Range: $65-$70/hr.
Position Overview
This position supports the successful migration to the Health Edge / Health Rules Payer (HRP) core system for Provider Network Operations (PNO). The role participates in cross-functional and multi-departmental workgroups, representing PNO priorities and workflows throughout system deployment.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care, with a mission that healthcare is a right, not a privilege.
Key Responsibilities
Support migration to Health Rules Payer (HRP) core claims system for Provider Network Operations
Participate in all phases of HRP rollout including preparation, testing, and post go-live activities
Maintain PNO issue tracker and support issue resolution impacting providers
Update process documentation, policies, and procedures related to HRP and PNO operations
Prepare executive summaries and communication materials related to HRP updates
Represent PNO leadership in operational and HRP-related meetings
Support additional critical PNO projects as needed
Perform provider data quality assurance across CACTUS, PowerStepp, HRP, and Salesforce systems
Monitor and triage provider complaints related to HRP migration
Perform data collection, extraction, analysis, and reporting related to HRP migration and PNO operations
Act as liaison between Credentialing, Provider Maintenance, and Customer Service teams
Investigate and respond to interdepartmental inquiries related to HRP and PNO processes
Perform additional duties as assigned
Required Skills & Experience
Cross-functional coordination and stakeholder management
Project coordination and operational support
Experience with provider data systems (CACTUS, PowerStepp, Salesforce)
Experience supporting system migrations (HRP/HealthEdge preferred)
Strong analytical skills including data collection, extraction, and reporting
Knowledge of provider network operations and healthcare systems
Understanding of provider hierarchy, contracts, Medicare fee schedules, CPT/HCPCS codes
General understanding of claims adjudication processes
Ability to manage multiple priorities and meet deadlines
Strong written and verbal communication skills
Ability to work independently and in a fast-paced environment
Strong proficiency in Microsoft Office tools
Education & Experience
Bachelor's degree required
3-5 years of experience in a health plan environment (Medicaid experience preferred)
Equivalent combination of education and experience accepted
Certifications & Licensure
None
Professional Competencies
Integrity and Trust
Customer Focus
Detail-oriented, organized, and dependable
Strong problem-solving and analytical abilities
Ability to manage workload independently and escalate issues appropriately
Ability to prepare reports and deliver presentations
Ability to interpret data and provide actionable recommendations
Ability to prioritize and work in a dynamic environment