Healthfirst

The Provider Operations Representative is responsible for processing requests to add new, and/or modify existing Provider records within MHS (Medical Health System). Additionally, they provide operational support for Network Management, Regulatory, Member Services, Provider Services, Credentialing, Claims, Medical Management, and Enrollment to ensure that our Provider database and subsequent reporting is as up-to-date and accurate as possible.

Job Description

• Conducting comprehensive and thorough review of requests for Provider profile set-up and/or updates initiated by other departments and received via Macess, fax, or e-mail for accuracy and completeness.
• Collaborating with internal and external customers to obtain any missing information required to complete requested set up and/or update.
• Entering Provider profile data into MHS database as requested.
• Identify inconsistencies and/or conflicts between Provider and Facility records.
• Validating Providers profile data for compliance with Provider set up guidelines as required to execute and file Providers application.
• Analyzing Provider records within MHS and compare the data against the initial set up instructions provided.
• Communicating discrepancies to both internal and external customers as appropriate to clarify and resolve any inconsistencies in order to ensure database accuracy.
• Maintaining a daily production sheet daily to include all work completed for the workday.
• Providing daily updates to Senior Representatives on the status of all active projects until completed.
• Managing work assigned through prioritization in order to meet expected completion deadlines for each request received.
• Communicating with department leadership to ensure that assigned workload can be completed as assigned.
• Participating in special projects as required.
• Additional duties as assigned

Minimum Qualifications

• High School diploma or GED equivalent from an accredited institution.
• Working knowledge of Microsoft Excel and Microsoft Word
• Working experience using a corporate e-mail system (i.e. Microsoft Outlook, Lotus Notes, etc.)
• Working experience in a production driven environment.
• Experience with data entry.

Preferred Qualifications

• Associate’s or Bachelor’s Degree from an accredited institution or equivalent work experience.
• Experience using MHS database.
• Basic knowledge of operational health plan departments and functionality.
• Excellent verbal and written communication and the ability to document grammatically correct emails, communications, and presentations.

Compliance & Regulatory Responsibilities: See Above

License/Certification: N/A

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $38,200 - $49,920

• All Other Locations (within approved locations): $33,300 - $47,840

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.