Provider File Specialist - Remote

EmblemHealth; New York (NY); On-site; USD 49,000 - 83,000; Full time

Job summary

EmblemHealth in New York seeks an Auditor to perform vendor performance audits and support provider data integrity across core processes. You will ensure adherence to contracts, regulatory expectations, and customer experience standards through routine audits, data analysis, and follow-up.

Responsibilities include conducting routine audits, documenting results, escalating trends, maintaining records, and contributing to cross-functional projects.

Qualifications

• Bachelor's degree required.
• 2-3+ years of auditing/assessment experience required.
• Strong collaboration and stakeholder communication skills required.
• Auditing skills applicable to various business problems.
• Excellent verbal, written, and presentation skills across audiences.
• Ability to manage multiple tasks/projects simultaneously.
• Experience with Provider Files or equivalent preferred.
• Proficiency in MS Office (Word, Excel, Access, PowerPoint, Outlook, Teams, SharePoint).

Responsibilities

• Audit vendor performance across core processes to ensure contractual requirements and customer experience objectives are met.
• Perform routine transactional reviews, audits, and compliance checks; document results and escalated trends to leadership.
• Investigate root causes, coordinate with partners and vendors, and document outcomes; escalate high-risk issues and suggest improvements.
• Maintain audit records; document findings, variances, and evidence; escalate results to management for corrective actions.
• Contribute to project activities and share knowledge within teams and workgroups.
• Share process knowledge and best practices with peers and new team members.

Skills

Auditing

Communication

Collaboration

Project management

Education

Bachelor's degree

Tools

MS Office

Job description

Summary Of Job

Conduct vendor performance auditing and support maintenance of provider data integrity across core operational processes. Ensure adherence to contractual requirements, regulatory expectations, and customer experience standards through routine audits and follow-up. Contribute to analytics and continuous improvement initiatives by compiling data, tracking results, and escalating issues as needed. Compile and share data quality and workflow findings with business partners; track follow-ups and escalated issues as needed.

Responsibilities

• Audit vendor performance for each core process to help ensure contractual requirements are met and results align with EmblemHealth customer experience objectives.
• Perform routine transactional reviews, audits, and compliance checks for vendor-supported processes; document results and escalated trends or issues to leadership.
• Resolve day-to-day operational issues by researching root causes, coordinating with business partners and vendors, and documenting outcomes; elevate higher-risk issues and recommend enhancements to management for prioritization and execution.
• Maintain audit and assessment records; document findings, variances, and supporting evidence; and escalated results to management for analysis and development of corrective actions.
• Complete project activities and contribute knowledge within project teams and workgroups aligned with department initiatives.
• Share process knowledge and best practices with peers and new team members as requested.
• Participate in cross-functional and vendor related projects as assigned.
• Perform other duties as directed, assigned, or required.

Qualifications

• Bachelor's degree
• 2-3+ years of relevant professional work experience including auditing and assessment activities (Required)
• Additional years of related experience/specialized training may be considered in lieu of degree requirements (Required)
• Strong collaboration skills and the ability to communicate effectively with stakeholders (Required)
• Strong auditing skills that can be applied across all types of business problems (Required)
• Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required)
• Ability to organize, prioritize, and successfully manage multiple competing tasks/projects simultaneously (Required)
• Previous Provider File or equivalent experience (Required)
• Proficient in MS Office - Word, Excel, Access, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)

Additional Information

• Requisition ID: 1000003222
• Hiring Range: $48,600-$83,160