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Healthfirst Sr. Provider Advocate-2 in New York, New York


Position Summary:

The Senior Provider Associate is responsible for the full range investigation, reporting and summarizing of end-to-end claims processing. The incumbent will nurture positive relationships between the health plan, Providers (physician, hospital, ancillary, etc.) and practice managers.

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Duties & Responsibilities:

Work within a team of Senior Provider Advocates and dedicated Senior Claims Examiners. Carry out supervisory responsibility in accordance with the organization’s policies and applicable laws. Responsibilities include, but are not limited to:

  • Responsible for conducting root cause analysis and working with staff in other business areas to assist with the resolution of complex Provider issues.

  • Achieve expected goals and outcomes within established timeframes. This includes keeping Network and Claims Management informed on progress of issues.

  • Through research, identifying gaps in contracting, MHS set-up and Provider’s billing practices. This is achieved through the reconciliation of the Provider’s account receivables (AR).

  • Using a Provider specific scorecard, identify billing trends and opportunities to reduce AR reconciliation

  • Educate Provider billing staff concerning changes in claims payments, medical policy and related operational procedures.

  • Coordinate prioritization and reprocessing of all identified claims.

  • Effectively track and prioritize multiple claims projects.

  • Develop and maintain professional and effective relationships with assigned Providers and with associates in key functional areas.

  • Identify defects and improve departmental performance by supporting quality, operational efficiency and production goals.

  • Report and present findings based on trending, interpretation and results.

  • Support Network Management and Providers from our office locations, on the field, or regular onsite visits with Providers.

  • Ensure adherence to departmental, corporate and governmental policies and regulations.

  • Additional duties as assigned.

    Minimum Qualifications:

  • High School Diploma or GED from an accredited institution.

  • Experience in a Claims and/or Provider Relations analytics role.

  • Experience with end-to-end claims processing and issue resolution.

  • Demonstrated experience in organizing and managing multiple detailed projects within expected timeframes

  • Mathematical skills with proficiency in preparing and analyzing reports using Excel.

  • Demonstrated ability in professional verbal and written communication skills.

  • Experience providing conflict resolution.

  • Experience leading project teams and providing evaluations and performance feedback.

  • Experience with health care insurance programs and reimbursement methodologies for facility and professional claims.

Preferred Qualifications:

  • Bachelor degree from and accredited institution.

  • Experience with Medicare, Medicaid and Commercial healthcare regulations

  • Knowledge of Power MHS

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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