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Job Overview
Location
Remote - FL
Job Type
Full-time
Category
Operations
Date Posted
December 19, 2025
Full Job Description
đź“‹ Description
- • Serve as the single point of accountability for delegated entities during provider onboarding and credentialing, owning the end-to-end resolution of every issue—whether surfaced by a physician, a clinic, or an internal partner—so that providers can focus on patient care instead of paperwork.
- • Build and nurture long-term relationships with assigned delegated entities by scheduling recurring touch-points, proactively identifying pain points, and delivering tailored training sessions that demystify Healthfirst’s onboarding and credentialing workflows.
- • Safeguard the integrity of the member experience by continuously auditing the online Provider Directory; investigate discrepancies, execute real-time updates, and certify that every listing remains accurate, compliant, and fully aligned with federal, state, and NCQA regulations.
- • Configure provider records in the MHS system for every new load, update, or termination, and step in as the go-to expert for large-scale, ad-hoc data-entry initiatives—ensuring that thousands of rows are processed with zero tolerance for error.
- • Own the quarterly roster reconciliation cycle: compare delegated entity rosters against internal systems, flag anomalies, and drive corrective actions so that the health-plan directory is always current and audit-ready.
- • Act as the gatekeeper for credentialing applications—receive, triage, and shepherd each file through verification, privileging, and approval—coordinating with hospitals, medical-staff offices, and practitioners to keep turnaround times best-in-class.
- • Review incoming provider contracts for completeness, partner with Network Management to finalize agreements, and relentlessly follow up until every signature is secured and every provider is loaded into production systems.
- • Translate complex regulatory language into clear, actionable guidance for providers and internal stakeholders, ensuring that everyone understands what “compliant” looks like and how to get there.
- • Leverage advanced Excel skills (VLOOKUPs, pivot tables, dynamic formulas) to build dashboards and ad-hoc reports that turn raw data into insights executives can act on.
- • Exhibit surgical time-management: juggle competing deadlines, pivot on last-minute executive requests, and still deliver flawless results without missing a beat.
- • Champion a culture of continuous improvement by surfacing workflow gaps, piloting automation ideas, and documenting best practices that future team members can replicate.
- • Model Healthfirst’s “members first” philosophy in every interaction—whether calming a frustrated provider or celebrating a delegated entity that just achieved 100 % roster accuracy.
- • Contribute to a remote-first team that spans Florida and the greater New York area, collaborating seamlessly across Zoom, Slack, and shared drives while maintaining the highest standards of data security and HIPAA compliance.
- • Report to the Team Lead and serve as a trusted escalation path for junior specialists, mentoring peers and raising the collective bar for quality and speed.
🎯 Requirements
- • Associate’s degree or higher
- • Demonstrated experience serving as a liaison between providers and internal support teams
- • Proven ability to meet tight deadlines and adapt to last-minute project requests while working independently with minimal supervision
- • Advanced proficiency in Microsoft Excel (VLOOKUP, pivot tables, formulas, reporting)
- • Preferred: Bachelor’s degree or higher; hands-on experience with MHS, DocuSign, and CRM software
🏖️ Benefits
- • Competitive salary range: $51,000–$75,905 for remote Florida residents; $58,900–$80,070 for Greater NYC area residents
- • Comprehensive medical, dental, and vision coverage for you and eligible dependents
- • 401(k) plan with company contributions, life insurance, and a full suite of wellness and recognition programs
- • Fully remote work environment with flexible scheduling and the autonomy to balance personal and professional priorities
Skills & Technologies
About Healthfirst, Inc.
Healthfirst is a New York-based health insurance provider offering affordable, comprehensive plans to individuals, families, and seniors. For over 30 years, the company has delivered diverse options, including Essential Plans, Medicaid Managed Care, Child Health Plus, Marketplace plans, and specialized Medicare Advantage and Long-Term Care solutions. Healthfirst offers benefits like medical, prescription drug, dental, and vision coverage. Notably, Healthfirst maintains the only 5-star rated Essential Plan in New York for two consecutive years, solidifying its position as a trusted leader in accessible community healthcare.
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