Provider Ops and Service Rep

Healthfirst is a not-for-profit managed care organization with a unique hospital-managed business model'allowing us to successfully deliver state and federally subsidized quality healthcare to more than 480,000 members through a network of close to 20,000 physicians and specialists.Operating in the five boroughs of New York City, Long Island and Westchester County in New York, and in Bergen, Essex, Hudson, Passaic and Union counties in New Jersey, Healthfirst has partnered with our participating hospitals to develop a solid and effective approach to meeting the ever-changing needs of the medically underserved. What's more, strong relationships with community-based organizations, schools, advocacy groups, local politicians, hospitals, governmental agencies and businesses allow Healthfirst to stay abreast of healthcare needs within the communities we serve and develop programs to meet them. Everyone at Healthfirst is committed to our members. Our Quality Improvement and Medical Management departments continue to develop effective and efficient treatment programs that maximize safe clinical practices and enhance service delivery while our participating providers ensure that members receive the highest possible quality care. As result, Healthfirst is the #1 Medicaid plan in New York State in terms of clinical quality. ' Enter and maintain provider information in the MHS Provider Database' Maintain and execute provider agreements for all lines of business. Verify that providers have consistent information listed on the agreement and have been activated prior to execution and filing' Enter crucial information for out of network providers to ensure timely payment of claims and the ability for the medical management department to authorize services ' Participate in special projects as requested' Represent the Provider Operations Unit in meetings/trainings ' Respond to provider correspondence inquiries regarding plan benefits, claim payment, and provider information.' Assist Correspondence staff concerning written inquiries for all products. ' Provide ongoing education, support, and assistance to the Provider Relations staff regarding plan benefits and procedural policies' Multi task duties assigned by the Provider Operations Managerial Team' Work cohesively and professionally both internally within the unit as well as within other departments as needed. ' High School Diploma required while college degree preferred ' Established data entry skills preferred' Analytical with a sharp eye for detailExperience:' Familiarity with Medicaid, Medicare, and Commercial regulationsExperience' Excellent problem solving and analytical skills' Ability to review the accuracy of claim payments, identify system flaws, and recommend areas for improvement' Working knowledge of medical terminology' Assertive, self-directed and resourceful' Ability to prioritize and perform multiple tasks at once