Network Ops Coordinator II

CareAllies Inc.; United States; Hybrid; USD 48,000 - 86,000; Full time

Job summary

CareAllies, based in Philadelphia, seeks a hybrid Provider Relations specialist responsible for HEDIS quality measures, wellness visits attestations, and data integrity. You will engage with providers, manage contracts and credentialing, and coordinate with internal teams.

The role emphasizes independent initiative, strong communication, and analytical skills to support value-based care. Travel to provider sites and office-based work three days a week expected.

Qualifications

• Bachelor's degree or 4 years of health care industry experience.
• 2 years of experience with Provider Network contracting and credentialing systems.
• Strong written and verbal communication skills.
• Analytical and quantitative skills.
• Ability to take initiative and work independently.

Responsibilities

• Overall performance and quality measures, including HEDIS and Medicare wellness attestations.
• Manage provider relationships and data integrity to support value-based care initiatives.
• Support network operations, cross-functional collaboration, and stakeholder engagement.
• Lead internal provider meetings and problem-solving for provider performance.

Skills

Written and verbal communication

Analytical and quantitative skills

Independent initiative

Education

Bachelor's degree or 4 years health care experience

Tools

Provider Network contracting systems

Population Health Management applications

Microsoft Office (Excel, PowerPoint)

Job description

At CareAllies, 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.

Job Summary

This Position Is Responsible for the following areas: Overall Performance/HEDIS Quality Measures, Medicare Annual Wellness Visit/Attestation Completion, Provider Relationship Management, Operations and Systems (Pop Health Platform, Sales Force Updates, Cross-Functional Collaboration (Internal and External Stakeholders) And Maintenance Of Professional Provider Data To Support Key Value-Based Care Initiatives, Membership And Network Operations. Building Relations With The Provider Community Is An Important Part Of This Role. Responsibilities Include Promoting High-Quality Initiatives To Support Data Integrity. Accepting Ownership And Leading Highly Specialized Operational And Provider Support Duties That Require Independent Initiative and Problem-Solving. This Role Includes Participating In Internal Provider Meetings And Work Groups, Researching Problems Related To Provider Performance/Engagement, Data And Network Participation.

Required Job Qualifications

• Bachelor degree OR 4 years of experience in the Health Care industry
• 2 years of experience with Provider Network contracting and credentialing systems
• 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

• Subject Matter Expert in Professional Provider Network Relations (claims service issues, contracting, and finance)
• Experience with Population Health Management applications and Microsoft Office Tools including Excel (VLOOKUPS, pivot tables) and Power Point.

Hybrid Work Arrangement

This Is a Hybrid Role based out of Philadelphia, PA - 80% of your time will be spent out in the field meeting with Providers. 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.

EEO 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.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned.

Pay Transparency Statement

At CareAllies, 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, a minimum of 15 days' of 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 full-time employees. The salary 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. Min to Max Range: $47,500.00 - $86,000.00 Exact compensation may vary based on skills, experience, and location.

Company Culture

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.