Description and Requirements

The DSI Specialist will assist with managing innovative provider contracts that further Healthfirst's mission of ensuring all members have access to high quality, affordable, and equitable healthcare.

This position includes project management responsibilities to ensure day-to-day operations run smoothly and large projects related to claims, contract implementation, and root cause analyses are carried out effectively and efficiently.

This position will work in collaboration with many other areas of Healthfirst and provides the opportunity to learn about all aspects of the Healthfirst business.

This position will report directly to the Manager, Key Accounts.

Responsibilities :

• Ensure Providers' issues and needs are responded to in a timely and accurate fashion.
• Educate and communicate Healthfirst benefits, policies, changes, and impacts to the practice.
• Ability to review a Provider issue and work across internal departments to identify root cause, operate in an analytical framework that can appropriately size issues, develop and implement an action plan to closure.

Assist management with research and facilitation of projects related to contract and reimbursement updates and implementation

Resolve configuration issues by identifying root causes to prevent claims denials and to ensure claims are paid correctly.

• Initiate application and credentialing process, managing all communications and paperwork for enrollment.
• Translate contract terms into system rules, e.g., configuration, creation, or amendment of new provider records, to ensure accuracy of future claims.
• Work directly with the Provider to improve clinical, quality, and member satisfaction outcomes. Ensure appropriate reports are available that allow practices to manage their patient populations (rosters, care plans, quality reports, etc.)
• Ensure effective communications amongst cross-functional teams (including scheduling meetings and follow-ups, and managing weekly and / or monthly reports).
• Work closely with numerous departmental partners, including operations, clinical quality, financial analysis, ancillary, population health, sales, and marketing.
• Master Health Insurance industry knowledge especially Healthfirst' s operating model by working closely with key individuals from various departments and showing willingness to learn.

Minimum Qualifications :

• Bachelor's degree or four to six years of relevant work experience in the healthcare industry
• Direct experience working with managed care operations and / or health plans
• Ability to work collaboratively, confidently, and influentially with various levels of stakeholders (internally and externally)
• Excellent organizational and problem-solving skills
• Strong communication skills (both verbal and written)
• Ability to take initiative and work independently
• Proficiency with Microsoft suite of applications

Preferred Qualifications :

Claims experience including root-cause analysis, system set-up, etc.

Hiring Range :

• Greater New York City Area (NY, NJ, CT residents) : $81,100 - $117,470
• All Other Locations (within approved locations) : $71,600 - $106,505

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.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, 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.