Provider Data Specialist

Headquarters Office, 625 State Street, Schenectady, New York, United States of America

• Rochester Office, 20 S. Clinton Ave, Rochester, New York, United States of America
• Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America Req #2456
  
  

Monday, March 3, 2025

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a Provider Data Specialist to join #TeamMVP. If you have a passion for data review and attention to detail , this is the opportunity for you.

What's In It For You

Growth opportunities to uplevel your career

A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team

Competitive compensation and comprehensive benefits focused on well - being

An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work for and one of the Best Companies to Work For in New York

Qualifications You'll Bring

An associates degree or equivalent combination of education and related experience

The availability to work full-time , virtual within New York State .

Two plus years of experience in health insurance or related office experience.

Detail oriented with excellent data entry skills including a high degree of accuracy.

Excellent computer and database skills including strong knowledge of Microsoft Word and Microsoft Excel.

Previous Credentialing experience preferred. Macess, Facets , and Catus preferred.

Curiosity to foster innovation and pave the way for growth

Humility to play as a team

Commitment to being the difference for our customers in every interaction

Your Key Responsibilities

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.

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.

Review and Process Provider and Mid-Level Registrations in accordance with MVP policies and procedures including but not limited to License Verification, DEA review, and regulatory sanction checks.

Research and update provider data elements as identified in provider data clean-up projects.

Perform outreach to providers and facilities for required data as needed.

Maintain all provider and facility data in Macess, Cactus and Facets systems.

Validate provider education, licensure, education and training, and perform mandated sanction checks such as Licensure, DEA or CDS Certificate, Board Certification if applicable, Medical or Professional education, Residency and Fellowship Training if applicable, Malpractice Insurance and History, Medicare sanctions and opt outs, Medicaid Management Information System (MMIS), National Practitioner Identification Number (NPI) through NPPES, Social Security Administration Death Master File through the National Technical Information Service (NTIS) database, and Clinical Privileges if applicable.

C ontribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Where You'll Be

Virtual within New York State

Pay Transparency

MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.

We do not request current or historical salary information from candidates.

MVP's Inclusion Statement

At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.

MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.

To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at hr@mvphealthcare.com .

Other Details

• Job Family Claims/Operations
• Pay Type Hourly
• Min Hiring Rate $20.00
• Max Hiring Rate $29.00