Healthfirst (501+ Employees, 13% 2 Yr Employee Growth Rate)
The Senior Provider Advocate (SPA) 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.
- Work within a team of Senior Provider Advocates and dedicated Senior Claims Examiners.
- Develop and maintain professional and effective relationships with assigned Providers and with associates in key functional areas.
- 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. Keep internal business partners informed on progress of any issues.
- Reconcile Provider account receivables (AR) and identify gaps in contracting, MHS set-up and Provider billing.
- 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.
- Track and prioritize multiple claims projects.
- 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 internal business partners and Providers from our office locations, including field offices, and regular onsite visits with Providers.
- Ensure adherence to departmental, corporate and governmental policies and regulations.
- Additional duties as assigned
- Bachelor’s degree from an accredited institution or equivalent work experience
- Experience in a claims processing, issue resolution, and/or Provider Relations role
- 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 to include meeting facilitation and presentation.
- Conflict resolution experience .
- Experience with healthcare insurance programs and reimbursement methodologies for facility and professional claims.
- Two or more years of experience within the managed healthcare industry.
- Experience with Medicare, Medicaid and Commercial healthcare regulations
- Knowledge of Power MHS
Please note: Since we care so greatly about our employees’ and members’ wellbeing, Healthfirst is moving to an environment where our employees are fully vaccinated against COVID-19. As a prospective new team member, you must be fully vaccinated with a CDC/FDA approved COVID-19 shot(s) to work in our offices. If you are selected to interview for this role, we will explain our vaccination policy in further detail and ensure you are comfortable moving forward with this company policy.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability 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 [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 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.
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.