Provider Data Operations Specialist
Description
- Serve as the single point of accountability for delegated entities during provider onboarding and credentialing, owning the end-to-end resolution of every issue—whether surfaced by a physician, a clinic, or an internal partner—so that providers can focus on patient care instead of paperwork.
- Build and nurture long-term relationships with assigned delegated entities by scheduling recurring touch-points, proactively identifying pain points, and delivering tailored training sessions that demystify Healthfirst’s onboarding and credentialing workflows.
- Safeguard the integrity of the member experience by continuously auditing the online Provider Directory; investigate discrepancies, execute real-time updates, and certify that every listing remains accurate, compliant, and fully aligned with federal, state, and NCQA regulations.
- Configure provider records in the MHS system for every new load, update, or termination, and step in as the go-to expert for large-scale, ad-hoc data-entry initiatives—ensuring that thousands of rows are processed with zero tolerance for error.
- Own the quarterly roster reconciliation cycle: compare delegated entity rosters against internal systems, flag anomalies, and drive corrective actions so that the health-plan directory is always current and audit-ready.
- Act as the gatekeeper for credentialing applications—receive, triage, and shepherd each file through verification, privileging, and approval—coordinating with hospitals, medical-staff offices, and practitioners to keep turnaround times best-in-class.
- Review incoming provider contracts for completeness, partner with Network Management to finalize agreements, and relentlessly follow up until every signature is secured and every provider is loaded into production systems.
- Translate complex regulatory language into clear, actionable guidance for providers and internal stakeholders, ensuring that everyone understands what “compliant” looks like and how to get there.
- Leverage advanced Excel skills (VLOOKUPs, pivot tables, dynamic formulas) to build dashboards and ad-hoc reports that turn raw data into insights executives can act on.
- Exhibit surgical time-management: juggle competing deadlines, pivot on last-minute executive requests, and still deliver flawless results without missing a beat.
- Champion a culture of continuous improvement by surfacing workflow gaps, piloting automation ideas, and documenting best practices that future team members can replicate.
- Model Healthfirst’s “members first” philosophy in every interaction—whether calming a frustrated provider or celebrating a delegated entity that just achieved 100 % roster accuracy.
- Contribute to a remote-first team that spans Florida and the greater New York area, collaborating seamlessly across Zoom, Slack, and shared drives while maintaining the highest standards of data security and HIPAA compliance.
- Report to the Team Lead and serve as a trusted escalation path for junior specialists, mentoring peers and raising the collective bar for quality and speed.
Requirements
- Associate’s degree or higher
- Demonstrated experience serving as a liaison between providers and internal support teams
- Proven ability to meet tight deadlines and adapt to last-minute project requests while working independently with minimal supervision
- Advanced proficiency in Microsoft Excel (VLOOKUP, pivot tables, formulas, reporting)
- Preferred: Bachelor’s degree or higher; hands-on experience with MHS, DocuSign, and CRM software
️ Benefits
- Competitive salary range: $51,000–$75,905 for remote Florida residents; $58,900–$80,070 for Greater NYC area residents
- Comprehensive medical, dental, and vision coverage for you and eligible dependents
- 401(k) plan with company contributions, life insurance, and a full suite of wellness and recognition programs
- Fully remote work environment with flexible scheduling and the autonomy to balance personal and professional priorities
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