Health First

posted 2 months ago

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 issues, as well as training and educating these entities on-site regarding the onboarding delegated process. In addition, 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 configure new provider loads, updates, and terminations, and provide assistance with large ad-hoc data entry projects in the MHS system. Your responsibilities will extend to 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 tasked with making required changes to ensure compliance. Furthermore, 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. This includes determining whether additional documentation, verifications, references, or applications are needed. You will also receive, review, and submit 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/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.
  • Submit provider contracts and coordinate with Network Management staff for approvals.

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 members.
  • Demonstrated flexibility and adaptability to changing priorities.
  • Strong time management skills to manage multiple tasks.
  • Computer proficiency (Excel, VLOOKUP, pivot tables, formulas, 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.
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