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Associate, Provider Data Specialist

1 month ago

Schenectady, United States MVP Health Care Full time
Associate, Provider Data Specialist

Headquarters Office, 625 State Street, Schenectady, New York, United States of America • Rochester Office, 20 S. Clinton Ave, Rochester, New York, United States of America • Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America • Virtual Req #2119

Wednesday, July 24, 2024

Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it's time to make a healthy career move to MVP

Full-Time, Non-Exempt

Position is virtual within New York State

The goal of this role is to handle all provider requests efficiently and accurately for onboarding and maintenance to provide:
  • Excellent member and provider experience- accurate and timely onboarding/credentialing and maintenance of provider data ensuring timely payment of claims. Provide excellent customer service for all inquiries and requests. Collaborate with the Network Management to ensure a robust provider network so that members needs are met especially in coverage areas with fewer facilities and providers. Continuously monitor providers' performance to ensure quality care for members.
Primarily responsible for provider data entry, management, verification and maintenance of MVPs Provider and Facility Network.

Primary Duties include:
  • Credential and recredential providers and facilities in accordance with MVP, NCQA, CMS, NYS Department of Health and all other regulatory agency guidelines.
  • Review and prepare files including clean files, issues, and red flag files for the MVP Credentials Committee.
  • Prepare letters to providers and facilities for credentialing/recredentialing/registration decisions and updates including non-compliance.
  • Review and Process Provider and Mid-Level Registrations in accordance with MVP policies and procedures including but not limited to License Verification, DEA review, and regulatory sanction checks.
  • Work in conjunction with Professional Relations and Network Management on projects including but not limited to directory verification, access and availability, deficiencies, provider quality issues, etc. to update provider demographic information.
  • Research and update provider data elements as identified in provider data clean-up projects.
  • Perform outreach to providers and facilities for required data as needed.
  • Maintain all provider and facility data in Macess, Cactus and Facets systems. Validate provider education, licensure, education and training, and perform mandated sanction checks such as Licensure, DEA or CDS Certificate, Board Certification if applicable, Medical or Professional education, Residency and Fellowship Training if applicable, Malpractice Insurance and History, Medicare sanctions and opt outs, Medicaid Management Information System (MMIS), National Practitioner Identification Number (NPI) through NPPES, Social Security Administration Death Master File through the National Technical Information Service (NTIS) database, and Clinical Privileges if applicable.
  • Gather and verify Provider data using several sources including but not limited to CAQH.
  • Manage provider demographic information to include all updates and provider-initiated changes.
  • Review and maintain non-participating provider claims from Facets and Macess with focus on the provider record only. Load new providers and update existing provider records. Ensure all regulatory claim payment timeframes are met.
  • Perform functions related to separation and termination of providers from the MVP Network including but not limited to researching providers, mailing termination letters, updating MVP systems, and coordinating the member notification process.
  • Perform Quality Control of identified provider data elements and primary source verification for new providers, provider changes, and provider separation/inactivation's entered into MVP core systems as outlined by department procedures.
  • All team members are expected to continuously evaluate processes, identify potential improvements, and help implement changes.
  • Performs other duties as assigned.
POSITION QUALIFICATIONS

Minimum Education
AA college degree in business or related business experience.

Minimum Experience
Two plus years of experience in a health insurance environment. Credentialing experience preferred.

Required Skills:
  • Excellent computer and database skills including strong knowledge of Microsoft Word and Microsoft Excel.
  • Detail oriented with excellent data entry skills including a high degree of accuracy.
  • Excellent written and oral communication skills, as well as interpersonal skills.
  • High degree of initiative and organization.
  • Ability to work successfully in independent setting.
  • Flexibility to adapt to continuously changing environment, willingness to learn.
  • Willingness to work additional hours as required.
  • Ability to handle stress and multiple competing priorities simultaneously
  • Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time
Preferred Skills:
  • Professional Relations Experience
  • Health Insurance Claims experience
  • Cactus
  • Facets
  • Macess
  • Excel

About MVP

MVP Health Care is a nationally recognized, not-for-profit health insurer caring for members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve.

At MVP, we are committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. Specific employment offers and associated compensation will be made individually based on several factors , including but not limited to geographic location ; relevant experience, education, and training; and the nature of and demand for the role.

In addition, we offer a comprehensive benefits package that includes:

  • Considerable paid time away from work including PTO (Paid Time Off), s ick t ime, service t ime o ff, p aid h olidays, and f loating h olidays , allowing you to take time off when it suits you best.
  • Competitive 401(k) employer matching and profit-sharing program to help you save for your retirement.
  • Low premium health benefits including medical, dental, and vision coverage to support your well-being and that of your family.
  • Life insurance and disability coverage to ensure financial security for you and your dependents.
  • An array of optional benefit plans such as accident insurance and specified disease coverage to protect you from the unexpected.
  • Full tuition reimbursement (up to the IRS limit) for approved courses and programs that support continuous learning.
  • A best-in-class employee Well-Being program to support all dimensions of your health and wellness.
MVP Health Care analyzes the latest market data to determine employee compensation. Compensation figures listed in a job posting are subject to change as new market data becomes available. The salary range, other compensation, and benefits information is accurate as of the date of this posting. MVP Health Care reserves the right to modify this information at any time, subject to applicable law. More detailed information about total compensation and benefits will be provided during the hiring process.

MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com

Please apply and learn more - including how you may become a proud member of our team.

Other details
  • Job Family Claims/Operations
  • Pay Type Hourly
  • Min Hiring Rate $20.00
  • Max Hiring Rate $28.00