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Healthfirst logo
Healthfirst

We provide no-and low-cost health insurance in NYC, Long Island, Orange, Rockland, Sullivan, and Westchester counties.

Provider Data Operations Specialist

OperationsOperationsOtherRemoteSeniorTeam 1,001-5,000Since 1993H1B SponsorCompany SiteLinkedIn

Location

Florida + 3 moreAll locations: Florida | Louisiana | Tennessee | Virginia

Posted

121 days ago

Salary

$51.9K - $80.1K / year

Seniority

Senior

Associate DegreeEnglish

Job Description

Provider Data Operations Specialist

Healthfirst

• 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

Job Requirements

  • 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
  • High School Diploma or GED equivalent from an accredited school.

Benefits

  • medical, dental and vision coverage
  • incentive and recognition programs
  • life insurance
  • 401k contributions

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