Work Schedule
This position requires three days per week in office (Tues/Wed/Thurs) at either: 1101 Greenwood Blvd. Lake Mary, FL. or 100 Church St. New York, NY.
Duties & Responsibilities:
Manages inbound requests for Provider Operations tasks including the daily Intake of tasks received from Provider Network and ensures timely completion of those tasks with minimal re-work.
Identifies opportunities for increased efficiency while maintaining high quality standards in alignment with company goals, regulatory compliance, and security requirements.
Establish clear and quantifiable policies & expectations for department Team Members related to productivity and quality of work in accordance with company goals and compliance requirements.
Maintain visibility of daily production activities including volume of work, completion times, and quality of outcomes through Individual and aggregate Team Performance Reporting.
Complete tasks and assignments on time and within established service level agreements.
Meet with Team Members no less than monthly to discuss team performance and address trends requiring improvement.
Recognize and reward employees for accomplishments and leverage performance improvement plans to ensure accountability as needed.
Collaborate with Stakeholders across the operations to implement process improvements across teams.
Establish individual performance goals for all team members.
Attend meetings and communicate relevant changes and updates as appropriate.
Hire, coach, and develop staff for advancement.
Attend to any human resource related matters within area of responsibility by collaborating with Sr. Leadership, Employee Connect, and HRBP
Collaborate with Operational Audit, Policy & Process Documentation, and Training Delivery Teams to ensure Job Aids, Training Materials and available tools and reference guides are aligned with the production environment and useful to team members.
Additional duties as assigned
Minimum Qualifications:
Moderate experience working with MS Office Suite to include adding/deleting rows/columns, creating simple formulas, creating standardized reports, and creating letters/memos.
Experience reading and interpreting data, identifying trends, recommending proactive solutions, and effectively communicating them to senior management.
Prior experience in a management role providing team leadership of exempt and non-exempt staff, including experience administering performance reviews, coaching, and disciplinary action, as well as conducting interviews, hiring, employee on-boarding, and terminations.
Experience evaluating risk, making sound decisions, and solving problems quickly and effectively.
Experience in an Operations area, managing high volume and complex repetitive tasks, in quality driven environment.
Experience dynamically adjusting day to day operations and effectively leveraging resources to accommodate unexpected, time sensitive tasks.
Previous experience managing competing priorities with effective communication.
Associate Degree from an accredited institution or equivalent experience.
Preferred Qualifications:
Knowledge of Medicare, Medicaid, Commercial and Consumer insurance guidelines
Previous experience collaborating on cross-functional processes as a subject matter expert (SME)
Experience working in health care industry specific to provider operations, including Provider Data Management, and/or Network Management.
Proficiency in medical terminology, claims workflows, and claims fundamentals.
Experience with improving and automating manual processes to reduce completion time, while minimizing errors, eliminating rework, and meeting quality expectations.
Experience in a Customer Service Environment with Internal and/or External business partners.
Experience with MS Visio and Process Mapping.
Basic understanding of Healthfirst systems such as: MHS, Macess, and Healthfirst Pega-Systems.
Understanding of Tableau Software, Qlik Cloud, HealthEdge Payer, Claims or Provider Data Management Modules.
Bachelor's degree from an accredited institution or equivalent experience.
Compliance & Regulatory Responsibilities: See above
License/Certification: NA
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.
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 [email protected] 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 HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.
Know Your Rights
All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430
All Other Locations (within approved locations): $88,700 - $131,920
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
Top Skills
What We Do
Healthfirst is a provider-sponsored health insurance company that serves 1.8 million members in downstate New York. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.
For more information on Healthfirst, visit www.healthfirst.org
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