Provider Operations Representatives is responsible for processing requests to add new, and/or modify existing Provider records within MHS (Medical Health System). Additionally, they provide operational support for Delivery System Engagement (DSE), Regulatory, Call Center Operations, Credentialing, Claims, Medical Management, and Enrollment to ensure that our Provider database and subsequent reporting is as up-to-date and accurate as possible.
Duties & Responsibilities:
- Conducting comprehensive and thorough review of requests for Provider profile set-up and/or updates initiated by other departments and received via Macess, fax, or e-mail for accuracy and completeness.
- Collaborating with internal and external customers to obtain any missing information required to complete requested set up and/or update.
- Entering Provider profile data into MHS database as requested.
- Identify inconsistencies and/or conflicts between Provider and Facility records.
- Validating Providers profile data for compliance with Provider set up guidelines as required to execute and file Providers application.
- Analyzing Provider records within MHS and compare the data against the initial set up instructions provided.
- Communicating discrepancies to both internal and external customers as appropriate to clarify and resolve any inconsistencies in order to ensure database accuracy.
- Maintaining a daily production sheet daily to include all work completed for the workday.
- Providing daily updates to Senior Representatives on the status of all active projects until completed.
- Managing work assigned through prioritization in order to meet expected completion deadlines for each request received.
- Communicating with department leadership to ensure that assigned workload can be completed as assigned.
- Participating in special projects as required.
- Additional duties as assigned
- High School Diploma or GED equivalent from an accredited school.
- Working experience in a data entry environment that requires meeting deadlines, quality results, and solving problems in a production environment.
- Flexible to work evenings, weekends and holidays due to business needs.
- Working experience with MS Excel to save in various versions, sort, filter, copy, paste, use pivot tables to determine work-flows.
- Associate's Degree from an accredited institution.
- Experience with MHS and/or MACESS preferred
- Self-driven and able to make process improvements.
- Time management skills and understands prioritizing.
- Ability to multi-task through various applications and database systems.
- Excel create pivot tables and utilize v-lookups
- Adaptable in a fast and changing environment.
- Working experience verbal and written communications.
- Working experience to perform constant repetitive tasks.
Compliance & Regulatory Responsibilities: 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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