Provider File Specialist

Req #:

2918

Job ID:

14397

Job Location:

New York, NY

Zip Code:

10041

Category:

Office and Administrative Support

Agency:

Elderplan

Status:

Regular Full-Time

Office:

Office-based

Salary:

$46,640.15 - $58,300.19 per year

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Why work for MJHS?:

When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No?  You will here!  You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals.  You take care of our patients, residents and health plan members, and we will take care of the rest!

 

Benefits include:

• Sign-on Bonuses OR Student Loan Assistance for clinical staff
• FREE Online RN to BSN and MSN degree programs!
• Tuition Reimbursement for all full and part-time staff
• Dependent Tuition Reimbursement for clinical staff!
• Generous paid time off
• Affordable medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities:

Handle all provider file update requests from participating providers, in accordance with the established timeline while developing and maintaining positive provider/customer services. The Provider File Specialist coordinates with various Elderplan Departments to ensure provider file update requests and demographic updates related to claim-denial inquiries are handled appropriately to facilitate the processing/reprocessing of these claims. They organize and submit correspondence from non-par providers for the Provider Data Maintenance Team (PDM) to process accordingly.

Qualifications:

High School diploma. Bachelor’s degree, preferred.
With Bachelor’s degree; minimum of one year of experience in Managed Care, provider billing, and/or customer service.
Without Bachelor’s degree, minimum of three (3) years of experience, as above.
Strong Microsoft Excel and data entry skills; ability to type approx. 45wpm.
Strong communication and interpersonal skills.
Minimum of 3 years of experience working in Elderplan’s Network Planning of Operations and experience with Cactus and HR Payor, highly preferred.

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