POSTED Jan 31

Provider Data Specialist at MVP Health Care

  • Data Entry
  • Fulltime
  • Anywhere (100% Remote) Only
Job Description

Full Job Description

Full-Time, Non-Exempt
Band: Associate II
Recruiter: Jan Cozzy
Referral Bonus eligible: Standard

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.
  • Perform outreach to providers and facilities for required data as needed.
  • 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 care environment.

    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
  • Credentialing Experience
  • Health Insurance Claims experience
  • Cactus
  • Macess
  • ExcelFull-Time, Non-Exempt

    Position can be remote/virtual within NY or VT

    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.
  • Perform outreach to providers and facilities for required data as needed.
  • 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 care environment.

    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
  • Credentialing Experience
  • Health Insurance Claims experience
  • Cactus
  • Macess
  • ExcelAbout MVP
    MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 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. 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. 
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