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Healthfirst Sr. Provider Operations Rep in Lake Mary, Florida


The Senior Provider Operations Representative is responsible for performing all duties of a Provider Operations Representative, as well as serving as resource for the Provider Ops Reps including training, coaching and guiding performance of Provider Ops Reps. This role will support the Supervisor as a resource department representative for cross-functional projects/meetings.

Duties and Responsibilities:

  • Responding to Provider Operations Representatives' questions, research issues, and root cause analysis.

  • Training new Provider Operations reps and conduct ongoing coaching.

  • Work closely with Network Management Coordinators, Representatives, and Third party Vendors (SHS) to identify demographic updates that need to be completed and/or assigned to the staff. Identify any submission issues and instructions prior to work being assigned.

  • Additional duties as assigned.

Minimum Qualifications:

  • High School Diploma OR GED from an accredited institution.

  • Working experience with MS Excel to save in various versions, sort, filter, copy, paste, use pivot tables, v-lookups to determine work-flows, track trends as well as track attendance of staff.

  • Working experience to coach and provide constructive feedback both face to face and in email.

  • Working experience using corporate email systems. (i.e. Outlook) as the primary means of communication within the department on changes/updates, coaching and external departmental requests.

  • Flexible to work evenings, weekends and holidays as business needs

  • Ability to think outside the box to drive results with little supervision.

  • Working experience multi-tasking various workloads at the same time, as well as shifting from one task to another at any given moment.

  • Previous working experience managing work-flow in a production inventory and deadline driven environment.

  • Ability to work in team environment, as well as meet individual goals.

Preferred Qualifications:

  • Associates Degree from an accredited institution.

  • Technology background preferred

  • Must have working experience in all of the following lines of businesses: Child Health Plus (CHP), Family Health Plus (FHP) PHSP, Medicaid, Medicare, Complete Care, Commercial, Health Exchange (HIX), Qualified Health Plans (QHP).

  • Working experience to research issues from MACESS and MHS submissions to identify the root cause and provide solutions and prevent future errors.

  • Experience working with SharePoint.

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 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.

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