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.

The MJHS Difference

At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services to diverse populations. We foster collaboration, celebrate achievements, and promote diversity, equity, and inclusion. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Benefits include:

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off, including your birthday!
• Affordable and comprehensive 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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