The Network Specialist will report directly to the Manager, Provider Network Operations to provide support with key operational functions that occur within DSE. The Network Operations Specialist will draft and maintain departmental policy and procedures and job aides for key departmental processes. They also serve as a resource and partners with to DSE teams implement non-standard/complex contracts. The work conducted by the Specialist will ensure compliance with departmental requirements that will reduce audit risk exposure and contribute towards streamlining operational efficiency
Works with Provider and Network Operations on identifying and resolving systemic issues that impact day to day DSE Operations (i.e. reporting level discrepancies, Specialists working as PCPs)
Manages multiple tasks independently within a fast paced proactive vs.reactive approach to changing priorities while meeting departmental objectives
Provides project management support to DSE teams for implementation of non-standard contracts
Investigates current state workflows within DSE and initiates drafting of policy and procedures and/or job aides as needed
Manages mass mailing projects within DSE as requested
Works with marketing to draft and release DSE provider communications as needed and maintain inventory of all provider communications.
Drafts and manages internal communications to DSE staff
Conducts trainings to DSE teams on policy and procedures as needed.
Proactively cultivates and maintains strong positive working relationships with internal customers
Additional duties as assigned.
Associate Degree from an accredited institution or applicable experience
Experience using excel or other software for data analysis
Experience with auditing reports, reviewing policies and procedures and workflows
Healthcare industry experience such as hospital, physician, ancillary, managed care
Working within one or more of the following areas: Managed Care, Network Management, Claims, Patient Accounts,
Creating reporting and tracking and trending performance
Strong organizational and time management skills
Strong critical thinking skills
MS Excel, Word
Bachelor's Degree from an accredited institution
Root Cause resolution
Cross functional experience in working as a liaison to internal business partners
Experience with Medicare, Medicaid and Commercial healthcare regulations.
Knowledge of Medicare and Medicaid programs and reimbursement methodologies.
Experience with conducting mail merges
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement