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Sr. Provider Advocate

Job Category: Processing & Operations

Location: New York, NY, United States

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Job Description

Description

The Senior Provider Advocate (SPA) is responsible for the full range investigation, reporting and summarizing of end-to-end claims processing. The incumbent will nurture positive relationships between the health plan, Providers (physician, hospital, ancillary, etc.) and practice managers.

 To view the video job description, watch here-> Sr. Provider Advocate,,  https://https://video.digi-me.com/healthfirst/jobs/healthcare/senior-provider-advocate/N40003

Duties & Responsibilities:

  • Work within a team of Senior Provider Advocates and dedicated Senior Claims Examiners.
  • Develop and maintain professional and effective relationships with assigned Providers and with associates in key functional areas.
  • Responsible for conducting root cause analysis and working with staff in other business areas to assist with the resolution of complex Provider issues.
  • Achieve expected goals and outcomes within established timeframes. Keep  internal business partners informed on progress of any issues.
  • Reconcile Provider account receivables (AR) and identify gaps in contracting, MHS set-up and Provider billing.
  • Identify billing trends and opportunities to reduce AR reconciliation
  • Educate Provider billing staff concerning changes in claims payments, medical policy and related operational procedures.
  • Coordinate prioritization and reprocessing of all identified claims.
  • Track and prioritize multiple claims projects.
  • Develop and maintain professional and effective relationships with assigned Providers and with associates in key functional areas.
  • Identify defects and improve departmental performance by supporting quality, operational efficiency and production goals.              
  • Report and present findings based on trending, interpretation and results.
  • Support internal business partners and Providers from our office locations, including field offices and regular onsite visits with Providers.
  • Ensure adherence to departmental, corporate and governmental policies and regulations.

Minimum Qualifications: 

  • Bachelor Degree from an accredited school or equivalent work experience
  • Experience in claims processing, issue resolution and/or Provider Relations  role.
  • Demonstrated experience in organizing and managing multiple detailed projects within expected timeframes
  • Mathematical skills with proficiency in preparing and analyzing reports using Excel.
  • Demonstrated ability in professional verbal and written communication skills to include meeting facilitation and presentation.
  • Conflict resolution experience.
  • Experience with health care insurance programs and reimbursement methodologies for facility and professional claims.

Preferred Qualifications: 

  • Two or more years of experience with managed care healthcare industry
  • Experience with Medicare, Medicaid and Commercial healthcare regulations
  • Knowledge of Power MHS

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, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

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