Provider Data Operations (PDO) Specialist

Duties/Responsibilities:

•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

Minimum Qualifications:

•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.

Preferred Qualifications:

•Bachelor’s Degree or above

•Experience with MHS, DocuSign and CRM software

•Compliance & Regulatory Responsibilities: N/A

•License/Certification: N/A

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services,  LLC.

Know Your Rights

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• 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.