Operations Specialist

Health First

Full-time

Ambulatory Health Care Services

About the position

As an Operations Specialist at Healthfirst, you will serve as the primary point of contact for all delegated and non-delegated entities concerning the onboarding and credentialing of providers. Your role will involve resolving issues that arise from both providers and internal sources that may impact physicians. You will be responsible for scheduling regular meetings with assigned delegated entities to identify and troubleshoot any issues that may arise, as well as training and educating these entities on-site regarding the onboarding delegated process. In addition to these responsibilities, you will conduct investigations to ensure that the online Provider directory is consistently updated and accurate. This includes making necessary changes to maintain the directory's accuracy at all times. You will also be tasked with configuring new provider loads, updates, and terminations, and providing assistance with large ad-hoc data entry projects within the MHS system. Your role will require performing quarterly roster reconciliations to ensure that the health plan directory remains current, accurate, and compliant with department guidelines, regulations, and government laws. You will be designated to receive and review provider credentialing applications, coordinating with hospitals, clinics, medical staff, and practitioners to ensure that the privileging process is completed in a timely manner. Additionally, you will determine if any additional documentation, verifications, references, or applications are needed. You will also be responsible for receiving, reviewing, and submitting provider contracts, coordinating with Network Management staff to finalize provider applications and contracts, and ensuring timely follow-up for approvals. Additional duties may be assigned as necessary.

Responsibilities

• Serve as the primary point of contact for onboarding and credentialing providers.
• Resolve issues identified by providers and internally that impact physicians.
• Schedule regular meetings with delegated entities to troubleshoot issues.
• Train and educate entities on the onboarding delegated process.
• Ensure the online Provider directory is updated and accurate.
• Configure new provider loads, updates, and terminations.
• Assist with large ad-hoc data entry projects in MHS.
• Perform quarterly roster reconciliations to maintain directory compliance.
• Receive and review provider credentialing applications.
• Coordinate with hospitals, clinics, and practitioners for timely privileging processes.
• Determine if additional documentation or verifications are needed.
• Receive, review, and submit provider contracts.
• Coordinate with Network Management staff to finalize applications and contracts.
• Follow up to ensure timely approval of provider applications.

Requirements

• Associate's degree or relevant work experience.
• Familiarity with Credentialing and Provider rosters.
• Understanding of Network Management.
• Experience working as a liaison with providers and internal support groups.
• Ability to meet deadlines under time-sensitive constraints.
• Experience adapting to last-minute project requests.
• Ability to work independently with minimal supervision.
• Effective communication skills with providers and internal staff.
• Demonstrated flexibility and adaptability to changing priorities.
• Strong time management skills with the ability to manage multiple tasks.
• Computer proficiency, including Excel, VLOOKUP, pivot tables, and reporting.
• Strong oral and written communication skills.
• Critical thinking skills.

Nice-to-haves

• Bachelor's Degree or above.
• Experience with MHS, DocuSign, and CRM software.