Provider Data Operations Specialist

Role Overview

• 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
• High School Diploma or GED equivalent from an accredited school.

Benefits

• medical, dental and vision coverage
• incentive and recognition programs
• life insurance
• 401k contributions