Description

The Network Operations Coordinator 4 maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Network Operations Coordinator 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.

Responsibilities

The Network Operations Coordinator 4 manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight.

Responsibilities

• Ensure data integrity and maintenance of the contracts.
• Ensures contracts are operationalized from contracting through implementation, leveraging standardized tools and quality processes end to end.
• Defined point of contact for Contracting and Provider Service (DCAV, PPG, Credentialing, Service Fund) regarding contract administration, data integrity, testing/auditing, maintenance (including annual escalators) attributions and contract clarifications for more complex contracts. This may include path-to-value and value-based contracts.
• Maintains contracts, including making changes and updates using various systems i.e. network add and deletes.
• Collaborates with Provider Engagement Executive or Senior Provider Engagement Professional to complete reassignment of membership.
• Ensures initial credentialing, managing unresponsive providers through re credentialing, and resolves discrepancies.

Required Qualifications

• High School Diploma or Equivalent
• 2 or more years of provider relations, provider contracting, provider loading or contract interpretation or provider auditing or related experience with another payer or provider.

• Proficient in Microsoft Office Suite, including strong Excel skills

• 2+ years of experience with provider contract maintenance

• Strong organization and multi-tasking skills

• Prior experience managing mid to large scale projects

Preferred Qualifications

• Bachelor’s Degree
• Previous account management or project management
• Knowledge with medical claims
• Data Analytics experience
• 2+ years of experience with CRM, CAS, APEX and the provider credentialling application
• 2+ years of experience in a Network Operations Coordinator 3 or 4 position
• Knowledge of Medicaid

Additional Information

This is a remote position

#LI-Remote

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40