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 providers or identified internally, are resolved effectively to maintain the integrity of the physician onboarding process. 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 protocols. A significant aspect of this position includes conducting thorough investigations to ensure that the online Provider directory is consistently updated and accurate. The individual 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). The role also requires performing quarterly roster reconciliations to ensure that the health plan directory remains current, accurate, and adheres to department guidelines, regulations, and government laws. The individual will be responsible for making required changes to ensure compliance with these standards. Furthermore, the position 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 individual will determine if additional documentation, verifications, references, or applications are needed and will also be responsible for receiving, reviewing, and submitting provider contracts. Coordination with Network Management staff to finalize provider applications and contracts is essential, along with 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.
• Investigate to ensure the online Provider directory is updated and accurate.
• Make necessary changes to maintain directory accuracy.
• Configure new provider loads, updates, and terminations.
• Assist with large ad-hoc data entry projects in MHS.
• Perform quarterly roster reconciliations to ensure 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.
• Ensure timely follow-up for provider application approvals.
• Perform additional duties as assigned.

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.
• Experience adapting to last-minute project requests.
• Experience working independently with minimal supervision.
• Ability to communicate effectively with providers and internal staff members.
• Demonstrated flexibility and adaptability to changing priorities.
• Time management skills with the ability to manage multiple tasks.
• Computer proficiency (i.e., 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.