Network Operation Coordinator Auditor

Humana Inc; Orlando (FL); Remote; USD 53,000 - 73,000; Full time

Job summary

Join a forward-thinking company dedicated to putting health first. As a Network Operations Coordinator 4 / Auditor, you will play a pivotal role in managing provider relations and ensuring data integrity. This position allows you to leverage your skills in provider audits and contract management while working in a supportive environment focused on personal wellness and smart healthcare decisions. With opportunities for remote work and occasional travel, this role offers a balanced approach to professional and personal growth. Your contributions will directly impact the quality of care delivered to millions, making this a truly rewarding opportunity.

Benefits

Medical Benefits

Dental Benefits

Vision Benefits

401(k) Retirement Plan

Paid Time Off

Short-term Disability

Long-term Disability

Life Insurance

Qualifications

• 2+ years of provider relations experience required.
• Intermediate skills in Microsoft Word and Excel needed.

Responsibilities

• Manage provider data and audits, ensuring data integrity.
• Communicate with providers via phone and email.

Skills

Provider Relations Experience

Microsoft Word

Microsoft Excel

Provider Contract Management

Project Management

Education

Bachelor's Degree

Tools

Humana APEX

PAAG

PMDM

Job description

Become a part of our caring community and help us put health first

The Network Operations Coordinator 4 /Auditor 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 / Auditor

• Manages provider data 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.

• Audit provider data- demographic, contract, service fund

• Submission for audit findings into APEX

• Phone and email communication with provider and contractor

Use your skills to make an impact

Required Qualifications

• 2 or more years of provider relations experience

• 1 or more years of working experience Humana APEX, PAAG and PMDM

• Intermediate experience with Microsoft Word

• Intermediate experience with Excel (pivot tables, formatting, v-lookup)

• Live in a state that's in the Eastern Standard Time (EST)

Preferred Qualifications

• Experience with provider contracts and/or maintain provider data

• Provider contract interpretation experience

• Previous account management and/or project management experience

• Working experience with medical claims

• Work independently and manage work load

Additional Information

Department hours- 8am to 5pm EST

Additional Information
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor.This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work at Home Guidance

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

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-BB1

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$53,100 - $72,500 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.