Operations Specialist

Health First

Full-time

Ambulatory Health Care Services

About the position

The position serves as the primary point of contact for all delegated and non-delegated entities concerning the onboarding and credentialing of providers. This role is crucial in ensuring that all issues, whether raised by the providers or identified internally, are resolved effectively. The individual will be responsible for scheduling regular meetings with assigned delegated entities to identify and troubleshoot any issues that may arise. Additionally, the role involves training and educating these entities on-site regarding the onboarding delegated process, ensuring that all parties are well-informed and compliant with the necessary procedures. A significant part of the job includes conducting investigations to maintain the accuracy of the online Provider directory. The individual will be tasked with making necessary changes to ensure that the directory is always up-to-date and compliant with department guidelines, regulations, and government laws. This includes configuring new provider loads, updates, and terminations, as well as providing assistance with large ad-hoc data entry projects within the Managed Health Services (MHS). The position also requires performing quarterly roster reconciliations to ensure that the health plan directory remains current and accurate. The individual 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 if additional documentation, verifications, references, or applications are needed. Furthermore, the role involves receiving, reviewing, and submitting provider contracts, as well as coordinating with Network Management staff to finalize provider applications and contracts, ensuring that all follow-ups are conducted for timely approvals. Additional duties may be assigned as necessary.

Responsibilities

• Act 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 through investigations.
• 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 for credentialing.
• 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.
• Experience meeting deadlines under time-sensitive constraints.
• Ability to adapt to last-minute project requests.
• Experience working independently with minimal supervision.
• Effective communication skills with providers and internal staff members.
• 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.