Healthfirst

The Senior Provider Associate is responsible for the full range investigation, reporting and summarizing of end-to-end claims processing. The incumbent will nurture positive relationships between the health plan, Providers (physician, hospital, ancillary, etc.) and practice managers.

Duties & Responsibilities:

• Work within a team of Senior Provider Advocates and dedicated Senior Claims Examiners.
• Develop and maintain professional and effective relationships with assigned Providers and with associates in key functional areas.
• Responsible for conducting root cause analysis and working with staff in other business areas to assist with the resolution of complex Provider issues.
• Achieve expected goals and outcomes within established timeframes. Keep internal business partners informed on progress of any issues.
• Reconcile Provider account receivables (AR) and identify gaps in contracting, MHS set-up and Provider billing.
• Identify billing trends and opportunities to reduce AR reconciliation
• Educate Provider billing staff concerning changes in claims payments, medical policy and related operational procedures.
• Coordinate prioritization and reprocessing of all identified claims.
• Track and prioritize multiple claims projects.
• Identify defects and improve departmental performance by supporting quality, operational efficiency and production goals.              
• Report and present findings based on trending, interpretation and results.
• Support internal business partners and Providers from our office locations, including field offices, and regular onsite visits with Providers.
• Ensure adherence to departmental, corporate and governmental policies and regulations.
• Additional duties as assigned

 Minimum Qualifications: 

• Bachelor’s degree from an accredited institution or equivalent work experience
• Experience in a claims processing, issue resolution, and/or Provider Relations role
• Demonstrated experience in organizing and managing multiple detailed projects within expected timeframes
• Mathematical skills with proficiency in preparing and analyzing reports using Excel.
• Demonstrated ability in professional verbal and written communication skills to include meeting facilitation and presentation.
• Conflict resolution experience .
• Experience with healthcare insurance programs and reimbursement methodologies for facility and professional claims.

Preferred Qualifications: 

• Two or more years of experience within the managed healthcare industry.
• Experience with Medicare, Medicaid and Commercial healthcare regulations
• Knowledge of Power MHS

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $65,600 - $94,775

• All Other Locations (within approved locations): $58,300 - $86,700

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.