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60 jobs near Columbus, OH

Healthfirst., Inc.

Credentialing Specialist

The Healthfirst Credentialing department credentials and re-credentials providers, facilities and vendors; prepares hard-copy directories and reviews network provider data for accuracy and ensures ...

Healthfirst., Inc.

Driver (CDL A, B or C)

New York, NY · On-site

The driver will ensure that Healthfirst Marketing Representatives, Facilitated Enrollers and Managers are in an acceptable environment to perform their function of enrolling members into our plans.

Healthfirst., Inc.

Clinical Auditor: Appeals and Grievances

$35.50 - $47.75/hr

The Clinical Auditor performs audit functions for Healthfirst clinical teams (e.g. Care Management, Reassessment/Clinical Eligibility, Utilization Management, etc.) and delegated vendors and partners ...

Healthfirst., Inc.

Operations Analyst

Lake Mary, FL · On-site

$51K - $74K/yr

Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $58,900 - $80,070 * All Other Locations ...

Healthfirst., Inc.

UM Pharmacy Technician-1

$18 - $21.75/hr

Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $47,403 - $64,338 * All Other Locations ...

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Credentialing Specialist

Healthfirst., Inc.

Remote

Full-time

Re-posted 16 days ago

Job description

The Healthfirst Credentialing department credentials and re-credentials providers, facilities and vendors; prepares hard-copy directories and reviews network provider data for accuracy and ensures compliance with regulatory requirements and federal and state regulations.
Duties/Responsibilities:
  • Credentials providers, facilities, and vendors in accordance to regulations and Healtfirst policy.
  • Prepares presentations for the quarterly credentialing and delegate vendor oversight committee meetings.
  • Facilitates pre-delegation and delegation vendor audits to ensure adherence to contractual arrangements.
  • Prepares hard-copy directories and works with third party vendors for posting online directories. Reviews relevant data to ensure accuracy.
  • Effectively communicates to internal departments and external partners.
  • Identifies and assesses opportunities to improve processes to better ensure regulatory compliance and adherence to state and federal regulations.
  • Raises issues to management and assists in resolution.
  • Additional duties as assigned.

Minimum Qualifications:
  • HS diploma/GED

Preferred Qualifications:
  • Bachelor's degree
  • Prior relevant experience
  • Time and project management, critical/creative thinking, communication, and problem-solving skills.
  • Intermediate Microsoft software skills include Adobe, Access, Excel, Word, PowerPoint, and Office

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 careers@Healthfirst.org 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.
EEO Law Poster and Supplement
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.

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