Provider Data Operations Specialist

HealthFirst

About The Position

The DSE Operations Specialist is a resource with in-depth account knowledge and is responsible for strengthening provider engagement and enhancing quality. This role will develop effective provider relationships that enhance Health first’s reputation as a “trusted partner” and supports administrative ease. Duties/Responsibilities: • Will be the primary point of contact for all delegated entities with regards to onboarding/credentialing providers. Responsible for the resolution of all issues, including those identified by the provider, and those identified internally that impact the physician. • Schedules regular meetings with assigned delegated entities to identify and trouble shoot issues. Trains/educates entities regarding the onboarding delegated process. • Responsible for investigations to ensure online Provider directory is updated and accurate. Makes all changes necessary to ensure the directory is at all times accurate. • Configures new Provider loads, updates and terminations. Provides assistance and guidance with large ad-hoc data entry projects in MHS. • Performs quarterly roster reconciliations to ensure that the health plan directory is current, accurate and adheres to department guidelines, regulations, and government laws. Tasked with making required changes to ensure directory is compliant. • Designated to receive and review provider credentialing applications. Coordinates with hospital/clinic, medical staff, and practitioners to ensure privileging process is timely completed. Determines whether additional documentation, verifications, references, and/or applications are needed. • Receives, reviews and submits provider contracts • Coordinates with Network Management staff to finalize provider applications and contracts. Responsible for all follow-up so that timely approval occurs. • Reports to Team Lead • Additional duties as assigned

Requirements

Associate's Degree or above.
Familiarity with Credentialing and Provider rosters
Understanding Network Management
Must have experience working as a liaison with providers and internal support groups
Must have experience meeting deadlines under time sensitive constraints
Must have experience adapting to last minute project requests
Must have experience working independently with minimal supervision
Must have ability to communicate effectively with providers and internal staff members
Demonstrated willingness to be flexible and adaptable to changing priorities
Time management skills with ability to manage multiple tasks
Computer proficient (i.e. excel, V lookup, pivot, formulas, reporting)
Oral and written communication skills
Critical thinking skills

Nice To Haves

Bachelor’s Degree or above
Experience with MHS, DocuSign and CRM software

Responsibilities

Will be the primary point of contact for all delegated entities with regards to onboarding/credentialing providers.
Responsible for the resolution of all issues, including those identified by the provider, and those identified internally that impact the physician.
Schedules regular meetings with assigned delegated entities to identify and trouble shoot issues.
Trains/educates entities regarding the onboarding delegated process.
Responsible for investigations to ensure online Provider directory is updated and accurate.
Makes all changes necessary to ensure the directory is at all times accurate.
Configures new Provider loads, updates and terminations.
Provides assistance and guidance with large ad-hoc data entry projects in MHS.
Performs quarterly roster reconciliations to ensure that the health plan directory is current, accurate and adheres to department guidelines, regulations, and government laws.
Tasked with making required changes to ensure directory is compliant.
Designated to receive and review provider credentialing applications.
Coordinates with hospital/clinic, medical staff, and practitioners to ensure privileging process is timely completed.
Determines whether additional documentation, verifications, references, and/or applications are needed.
Receives, reviews and submits provider contracts
Coordinates with Network Management staff to finalize provider applications and contracts.
Responsible for all follow-up so that timely approval occurs.
Reports to Team Lead
Additional duties as assigned