Provider Data Services Specialist Associate

Burlington Office, 62 Merchants Row, Williston, Vermont, United States of America ● Headquarters Office, 625 State Street, Schenectady, New York, United States of America ● Rochester Office, 220 Alexander Street, Rochester, New York, United States of America ● Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America ● Virtual Req #1213
Tuesday, August 23, 2022
Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow.  We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds—tech people, numbers people, even people people—working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference—it’s time to make a healthy career move to MVP!

There are some positions at MVP where your work may require an onsite or community component. When working in an MVP office and/or in the community on behalf of MVP, you must be fully vaccinated against COVID-19, and have received the first booster dose within one month of eligibility.

The goal of this role is to handle all provider requests efficiently and accurately for onboarding and maintenance to provide:

  • Excellent member and provider experience- accurate and timely onboarding/credentialing and maintenance of provider data ensuring timely payment of claims. Provide excellent customer service for all inquiries and requests. Collaborate with the Network Management to ensure a robust provider network so that members needs are met especially in coverage areas with fewer facilities and providers. Continuously monitor providers’ performance to ensure quality care for members.

Primarily responsible for provider data entry, management, verification and maintenance of MVPs Provider and Facility Network.
 

Primary Duties include:

  • Credential and recredential providers and facilities in accordance with MVP, NCQA, CMS, NYS Department of Health and all other regulatory agency guidelines.
  • Review and prepare files including clean files, issues, and red flag files for the MVP Credentials Committee.
  • Prepare letters to providers and facilities for credentialing/recredentialing/registration decisions and updates including non-compliance.
  • Perform outreach to providers and facilities for required data as needed.
  • All team members are expected to continuously evaluate processes, identify potential improvements, and help implement changes.
  • Performs other duties as assigned.

POSITION QUALIFICATIONS


Minimum Education
AA college degree in business or related business experience.


Minimum Experience
Two plus years of experience in a health insurance environment.

Required Skills:

  • Excellent computer and database skills including strong knowledge of Microsoft Word and Microsoft Excel.
  • Detail oriented with excellent data entry skills including a high degree of accuracy.
  • Excellent written and oral communication skills, as well as interpersonal skills.
  • High degree of initiative and organization.
  • Ability to work successfully in independent setting.
  • Flexibility to adapt to continuously changing environment, willingness to learn.
  • Willingness to work additional hours as required.
  • Ability to handle stress and multiple competing priorities simultaneously
  • Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time.
  • Must be NY or VT state resident

Preferred Skills:

  • Professional Relations Experience
  • Credentialing Experience
  • Health Insurance Claims experience
  • Cactus
  • Macess

About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal.  We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com
 

Please apply and learn more – including how you may become a proud member of our team.

Other details

  • Job Family Claims/Operations
  • Pay Type Hourly
This posting is inactive.
Location on Google Maps
  • Burlington Office, 62 Merchants Row, Williston, Vermont, United States of America
  • Headquarters Office, 625 State Street, Schenectady, New York, United States of America
  • Rochester Office, 220 Alexander Street, Rochester, New York, United States of America
  • Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America
  • Virtual