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Operations Specialist - Provider Data Management

Job Category: Contracting & Credentialing

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Location: Lake Mary, FL, United States

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Job Description


The Provider Data Management, Operations Specialist is a resource with in-depth account knowledge and is responsible for strengthening provider engagement and enhancing quality. This role will develop effective provider relationships that enhance Health first’s reputation as a “trusted partner” and supports administrative ease.

Duties/Responsibilities Include:

  • 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 on site 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.
  • Additional duties as assigned

Minimum Qualifications:

  • High School Diploma/GED
  • 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:

  • Bachelor’s Degree or above
  • Experience with MHS, DocuSign and CRM/CAQH Softwares
  • Familiarity with Credentialing and Provider rosters

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, 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 [email protected] 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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