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Operations Specialist

4 months ago

Baton Rouge, Louisiana, United States Health First Full time

**This position is Remote.

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 on site 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:

High School diploma/equivalent, or above

Understanding Network Management

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 internal and external stakeholders

Demonstrated willingness to be flexible and adaptable to changing priorities

Time management skills with ability to manage multiple tasks

Computer proficient (i.e. MS Office and other Windows apps. i.e. Excel, Word, Outlook)

Oral and written communication skills

Critical thinking skills

Preferred Qualifications:

Associate degree or above.

Experience with MHS, DocuSign and CRM software

Compliance & Regulatory Responsibilities: See Above

License/Certification: N/A