Network Operations Coordinator I

hcsc; Richardson (TX); On-site; USD 41,000 - 73,000; Full time

Job summary

HCSC is seeking a detail-oriented professional to manage contracting, credentialing, and provider data to support multiple business lines. You will coordinate with network contracting and data teams to ensure accurate data and timely responses to provider inquiries.

The role emphasizes collaboration, problem-solving, and independent work in a fast-paced health plan environment with opportunities for growth and professional development.

Qualifications

• 2 years of college OR two years of relevant experience.
• Written and verbal communication with internal/external customers.
• Analytical and quantitative skills.
• Ability to take initiative and work independently.
• Experience with healthcare provider data and provider offices.
• 1 year of experience on Premier Provider Data systems.
• Knowledge of Professional Provider Credentialing processes.
• Experience supporting ACA RADV activities, medical record retrieval, or audit support.
• Experience in claims processing/research/resolution in a health-plan setting.
• Strong investigative and problem-solving skills to resolve discrepancies.
• Experience in high-volume call center or provider/claims inquiries.
• Ability to manage high-volume workload with minimal supervision.

Responsibilities

• Contracting, credentialing, and maintenance of Professional Provider Data.
• Support Marketing, Membership and Network Contracting across lines of business.
• Attend internal meetings and work groups; research credentialing problems.
• Liaison between Network Contracting and Provider Data Management.
• Process provider data requests and ensure data accuracy.

Skills

Communication skills

Analytical skills

Initiative

Independent work

Education

2 years of college

Tools

Premier Provider Data systems

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for the contracting, credentialing, and maintenance of Professional Provider Data to support Marketing, Membership and Network Contracting across all lines of business. This includes providing accurate and timely administration of provider contracts, rosters and requests supporting quality initiatives to ensure data accuracy. Responsibilities including internal provider meetings and work groups, researching problems related to provider credentialing, data and network participation. Includes working as a Liaison between Network Contracting and Provider Data Management for credentialing and network activities.

Required Job Qualifications

• 2 years of college OR two years of experience
• Written and verbal communication skills to interact with internal and external customers
• Analytical and quantitative skills
• Ability to take initiative and work independently

Preferred Job Qualifications

• Experience working directly with healthcare providers and provider offices to obtain information, resolve issues, and support business operations.
• 1 year of experience on the Premier Provider Data systems.
• Existing knowledge of Professional Provider Credentialing processes.
• Experience supporting Affordable Care Act (ACA) Risk Adjustment Data Validation (RADV) activities, medical record retrieval, audit support, or related initiatives.
• Claims processing, claims research, or claims resolution experience within a healthcare or health plan environment.
• Strong investigative and problem-solving skills with the ability to research discrepancies, gather information, and drive issues to resolution.
• Experience working in a high-volume call center or customer service environment, preferably handling provider or claims-related inquiries.
• Ability to work independently, take initiative, and effectively manage a high-volume workload with minimal supervision.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range

$40,500.00 - $72,500.00

Exact compensation may vary based on skills, experience, and location.