Healthfirst

The DSE Operations Specialist will report directly to the Team Lead. They will apply in-depth account knowledge focusing on strengthening provider engagement and enhancing quality. This role will develop effective provider relationships to support administrative ease and enhance Healthfirst reputation as a “trusted partner”.

Duties/Responsibilities:

• Functions as the primary point of contact for all delegated and non-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 and non-delegated entities to identify and trouble shoot issues. Trains/educates entities on site 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.
• Reviews work of Operations Specialist for quality and provides guidance where improvement is needed.
• Coordinates and oversees special projects in collaboration with Management.
• Serves as SME for all Intake Processes and Work.
• Additional duties as assigned.

Minimum Qualifications:

• Previous experience as Operation Specialist, or similar role
• Advanced knowledge of systems used by Intake such as PLM< Macess, MHS, PITS, SharePoint etc.
• Intermediate knowledge of Microsoft Office Applications (Excel, Outlook, Word)

Preferred Qualifications:

• Experience coordinating the work of others, to include assignment, SLA and metric monitoring and compliance, reporting.
• Intermediate knowledge of reporting tools (Excel Pivot tables, Tableau, Qlickview)

Compliance & Regulatory Responsibilities: See Above

License/Certification: N/A

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $56,000 - $76,160

• All Other Locations (within approved locations): $48,600 - $72,335

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.