Healthfirst is looking for a Provider Data Operations Specialist to strengthen provider engagement and enhance the quality of our network data. This role acts as the primary point of contact for delegated entities, supporting provider onboarding, credentialing, and data integrity.
What You'll Do
- Act as the primary point of contact for all delegated entities regarding provider onboarding and credentialing, resolving all related issues.
- Schedule regular meetings with assigned delegated entities to identify, troubleshoot, and train on the onboarding process.
- Investigate and ensure the online Provider Directory is accurate, making all necessary updates.
- Configure new provider loads, updates, and terminations, and assist with large ad-hoc data entry projects in MHS.
- Perform quarterly roster reconciliations to ensure the health plan directory is current, accurate, and compliant.
- Receive and review provider credentialing applications, coordinating with medical staff to ensure timely completion.
- Receive, review, and submit provider contracts.
- Coordinate with Network Management staff to finalize provider applications and contracts, following up for timely approval.
What We're Looking For
- An Associate's Degree or higher.
- 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 and adapting to last-minute project requests.
- Experience working independently with minimal supervision.
- Ability to communicate effectively 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, including Excel (VLOOKUP, pivot tables, formulas, reporting).
- Strong oral, written, and critical thinking skills.
Nice to Have
- A Bachelor’s Degree or higher.
- Experience with MHS, DocuSign, and CRM software.
Technical Stack
- MHS
- Excel
- DocuSign
- CRM software
Team & Environment
You will report directly to a Team Lead.
Benefits & Compensation
- Medical, dental, and vision coverage.
- Incentive and recognition programs.
- Life insurance.
- 401k contributions.
- Compensation: $58,900 - $80,070 for Greater New York City Area (NY, NJ, CT residents); $51,000 - $75,905 for All Other approved locations.
Work Mode
This role is based locally within approved locations, including the Greater New York City Area (NY, NJ, CT) or other approved areas.
HF Management Services, LLC complies with all applicable laws and regulations and considers all applicants and employees without regard to legally protected characteristics.
