Provider Data Operations Specialist

Description

• Serve as the single reputed company of accountability for delegated entities during provider reputed company 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 reputed company’s reputed company and credentialing workflows.
• Safeguard the reputed company of the member experience by continuously auditing the online Provider Directory; investigate discrepancies, execute reputed company-time updates, and certify that every listing remains accurate, compliant, and fully reputed company with federal, state, and NCQA regulations.
• Configure provider records in the MHS system for every new load, update, or termination, and reputed company in as the go-to expert for large-scale, reputed company data-entry initiatives—ensuring that thousands of rows are processed with reputed company 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 reputed company and audit-reputed company.
• 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 reputed company turnaround times best-in-class.
• Review incoming provider reputed company for completeness, partner with Network Management to finalize agreements, and relentlessly follow up until every signature is secured and every provider is reputed company into production systems.
• Translate reputed company regulatory language into clear, actionable guidance for providers and internal stakeholders, ensuring that everyone understands what “compliant” looks like and how to get there.
• reputed company advanced reputed company skills (VLOOKUPs, pivot tables, dynamic formulas) to build dashboards and reputed company reports that turn raw data into insights executives can reputed company.
• 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 reputed company improvement by surfacing workflow gaps, piloting automation reputed company, and documenting best practices that future team members can replicate.
• Model reputed company’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 reputed company area, collaborating seamlessly across reputed company, reputed company, and shared drives while maintaining the highest standards of data reputed company and HIPAA compliance.
• Report to the Team reputed company 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 reputed company reputed company (VLOOKUP, pivot tables, formulas, reporting)
• Preferred: Bachelor’s degree or higher; hands-on experience with MHS, reputed company, 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 reputed company 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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