Network Operations Coordinator

Humana; United States; Remote; USD 53,000 - 73,000; Full time

Job summary

Join a forward-thinking company dedicated to health and well-being. As a Network Operations Coordinator, you'll play a crucial role in managing provider relations and ensuring data integrity for health plans. This position offers the opportunity to work with various systems and collaborate with professionals to enhance service delivery. If you're passionate about making a positive impact in the healthcare sector and possess strong organizational skills, this role is perfect for you. Enjoy a competitive salary and comprehensive benefits while working in a supportive environment that values your contributions.

Benefits

Medical insurance

Dental insurance

Vision insurance

401(k)

Paid time off

Disability insurance

Life insurance

Qualifications

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

Responsibilities

• Manage provider data and ensure data integrity for health plans.
• Act as point of contact for contract administration and service.

Skills

Provider relations experience

Microsoft Word

Microsoft Excel

Provider contract interpretation

Ability to handle multiple projects

Education

High School Diploma or equivalent

Associate’s Degree

Bachelor’s Degree

Tools

APEX

CAS

PMDM

Job description

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 manages provider perceived service failures. Ensures 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.
• Acts as the 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, including path-to-value and value-based contracts.
• Utilizes APEX, CAS, and PMDM systems.
• Maintains contracts, including making changes and updates using various systems, e.g., network add and deletes.
• Collaborates with Provider Engagement Executives or Senior Provider Engagement Professionals to complete reassignment of membership.
• Ensures initial credentialing, manages unresponsive providers through re-credentialing, and resolves discrepancies.
• Manages operational issues related to data integrity with assigned providers.
• Works 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 of medical claims
• Ability to handle multiple projects simultaneously

Additional Information

As part of our hiring process, we will use HireVue, an interviewing technology that allows us to connect quickly and gather relevant information about your skills and experience at your convenience.

Work At Home / Internet Requirements:

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps recommended; wireless, wired cable, or DSL connection suggested
• Satellite, cellular, and microwave connections require leadership approval
• Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly internet expense payment
• Humana provides necessary telephone equipment for remote work
• Work from a dedicated, interruption-free space to protect member PHI/HIPAA information

For questions, contact the Ask A Recruiter persona via go/Buzz and search 'Ask A Recruiter' with your requisition number.

Travel may be required occasionally for training or meetings at Humana offices.

Scheduled Weekly Hours:

40 hours

Pay Range:

$53,100 - $72,500 annually, depending on location and experience.

Benefits:

Humana offers competitive benefits supporting overall well-being, including medical, dental, vision, 401(k), paid time off, disability, life insurance, and more.

About us

Humana is committed to putting health first for our members, employees, and communities through innovative healthcare and insurance services.

Equal Opportunity Employer

Humana does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status, and promotes affirmative action in employment.

About the company

Humana works to create personalized health paths for each individual, supporting their unique needs.