Operations Specialist

Health First

Full-time

Ambulatory Health Care Services

About the position

The Operations Specialist 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 to maintain the integrity of the physician network. 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 these entities on-site regarding the onboarding delegated process, ensuring that all parties are well-informed and compliant with the necessary protocols. A significant aspect of this role includes conducting investigations to ensure that the online Provider directory is consistently updated and accurate. The Operations Specialist will be tasked with making necessary changes to maintain the directory's accuracy at all times. This includes configuring new provider loads, updates, and terminations, as well as providing assistance and guidance with large ad-hoc data entry projects within the Managed Health Services (MHS) framework. The Operations Specialist will perform quarterly roster reconciliations to ensure that the health plan directory remains current, accurate, and adheres to department guidelines, regulations, and government laws. This role is also 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. The Specialist will determine if additional documentation, verifications, references, or applications are needed to facilitate this process. Furthermore, the Operations Specialist will receive, review, and submit provider contracts, coordinating with Network Management staff to finalize provider applications and contracts. This position is responsible for all follow-up actions to ensure that timely approvals occur, thereby supporting the overall efficiency of the onboarding and credentialing processes. Additional duties may be assigned as necessary to support the operations team.

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 (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.