Provider Data Operations; PDO Specialist

The DSE Operations Specialist is a resource with in-depth account knowledge and is responsible for strengthening provider engagement and enhancing quality. This role will develop effective provider relationships that enhance Healthfirst’s reputation as a “trusted partner” and supports administrative ease.

• 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 troubleshoot 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

• 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.

• Bachelor’s Degree or above
• Experience with MHS, Docu Sign and CRM software
• Compliance & Regulatory Responsibilities: N/A
• License/Certification: N/A

• Greater New York City Area (NY, NJ, CT residents): $58,900 - $80,070
• All Other Locations (within approved locations): $51,000 - $75,905

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.