Network Operations Coordinator

Humana Inc; Indiana (PA); 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, you'll play a vital role in managing provider relations and ensuring data integrity for health plans. Your expertise will help streamline processes and improve service operations, making a real impact on the community. This position offers the chance to work in a supportive environment where your contributions are valued, and your skills can shine. If you're looking to advance your career in a meaningful way, this opportunity is perfect for you.

Benefits

Work from home flexibility

Health insurance

Retirement savings plan

Paid time off

Professional development opportunities

Qualifications

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

Responsibilities

• Manage provider data and relations for health plans effectively.
• Ensure data integrity and maintain contracts with providers.

Skills

Provider relations experience

Microsoft Word

Microsoft Excel

Provider contract interpretation

Education

High School Diploma

Associate’s Degree

Bachelor’s Degree

Tools

APEX

CAS

PMDM

Job description

Job Profile

Network Operations Coordinator 4

Job Level

Representative 4

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

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 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. Ensure data integrity and maintenance of the contracts. Works within broad guidelines with little oversight.

• 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.

• Utilizes APEX, CAS, and PMDM systems.

• 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.

• Manage operational issues related to data integrity with assigned providers.

• Work with Contract Directors to assist with and follow up on routine provider contracts, as needed.

Use your skills to make an impact

Required Qualifications

• High School Diploma or equivalent

• 2 or more years of provider relations experience

• Intermediate experience in Microsoft Word and Excel

• Provider contract interpretation experience

Preferred Qualifications

• Associate’s or Bachelor’s Degree

• Knowledge with medical claims

• Ability to handle multiple projects simultaneously

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVu allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work At Home / Internet Information:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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

• Employees 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 employees 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

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

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

Referral Bonus Information

This requisition is not eligible for a referral bonus.

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.