Operations Specialist

Health First

Full-time

Ambulatory Health Care Services

About the position

The Operations Specialist at Healthfirst will serve 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 providers or identified internally, are resolved effectively. The Operations Specialist will be responsible for scheduling regular meetings with assigned delegated entities to identify and troubleshoot any issues that may arise. Additionally, this position involves training and educating entities on-site regarding the onboarding delegated process, ensuring that all parties are well-informed and compliant with the necessary protocols. A significant part of the role includes conducting investigations to maintain the accuracy of the online Provider directory. The Operations Specialist 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 Operations Specialist will also perform quarterly roster reconciliations to ensure that the health plan directory remains current and accurate. This involves receiving and reviewing provider credentialing applications, coordinating with hospitals, clinics, medical staff, and practitioners to ensure that the privileging process is completed in a timely manner. The role requires determining whether additional documentation, verifications, references, or applications are needed to facilitate this process. Furthermore, the Operations Specialist will be responsible for receiving, reviewing, and submitting provider contracts, as well as coordinating with Network Management staff to finalize provider applications and contracts. Timely follow-up is essential to ensure that approvals are obtained without unnecessary delays. The position reports directly to the Manager and may include additional duties as assigned.

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 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 additional documentation or verifications 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.
• 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 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.