• Provider Data Operations Specialist

    Healthfirst (NY)


    Duties/Responsibilities:

    Will be the primary point of contact for all delegated entities with regards to onboarding/credentialing providers. Responsible for the resolution of all issues, including those identified by the provider, and those identified internally that impact the physician.

     

    Schedules regular meetings with assigned delegated entities to identify and trouble shoot issues. Trains//educates entities regarding the onboarding delegated process.

     

    Responsible for investigations to ensure online Provider directory is updated and accurate. Makes all changes necessary to ensure the directory is at all times accurate.

     

    Configures new Provider loads, updates and terminations. Provides assistance and guidance with large ad-hoc data entry projects in MHS.

     

    Performs quarterly roster reconciliations to ensure that the health plan directory is current, accurate and adheres to department guidelines, regulations, and government laws. Tasked with making required changes to ensure directory is compliant.

     

    Designated to receive and review provider credentialing applications. Coordinates with hospital//clinic, medical staff, and practitioners to ensure privileging process is timely completed. Determines whether additional documentation, verifications, references, and//or applications are needed.

     

    Receives, reviews and submits provider contracts

     

    Coordinates with Network Management staff to finalize provider applications and contracts. Responsible for all follow-up so that timely approval occurs.

     

    Reports to Team Lead

     

    Additional duties as assigned

    Minimum Qualifications:

    Associate's Degree or above.

     

    Familiarity with Credentialing and Provider rosters

     

    Understanding Network Management

     

    Must have experience working as a liaison with providers and internal support groups

     

    Must have experience meeting deadlines under time sensitive constraints

     

    Must have experience adapting to last minute project requests

     

    Must have experience working independently with minimal supervision

     

    Must have ability to communicate effectively with providers and internal staff members

     

    Demonstrated willingness to be flexible and adaptable to changing priorities

     

    Time management skills with ability to manage multiple tasks

     

    Computer proficient (i.e. excel, V lookup, pivot, formulas, reporting)

     

    Oral and written communication skills

     

    Critical thinking skills

    Preferred Qualifications:

    Bachelors Degree or above

     

    Experience with MHS, DocuSign and CRM software

     

    Compliance & Regulatory Responsibilities: N/A

    License//Certification: N/A

    WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.