Network Operations Coordinator 4

Company: Humana
Location: San Antonio
Posted on: November 22, 2021

Job Description:

**Description**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 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.How we Value YouBenefits starting day 1 of employmentCompetitive 401k matchGenerous Paid Time Off accrualTuition ReimbursementParent LeaveGo365 perks for well-being**Responsibilities**Working with provider data provider data, provider directories, and/or contract managementThe Network Operations Coordinator 4 (NOC) is an important part of the regional Provider Development team and is accountable for maintaining accurate data for assigned providers. The NOC also processes contracts, conducts audits, manages credentialing and a variety of other network management projects. The NOC works within several complex provider data management systems and maintains proficiency with basic Office, and internal applications required to perform job duties. The NOC collaborates with contractors, and other functional areas to problem solve and otherwise ensure a positive provider and member experience. Must be able to work independently, managing time and productivity with little oversight.+ Inbound and Outbound calls to providers to verify data+ Ensure data integrity and maintenance of the contracts.+ 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.+ 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.**Required Qualifications**+ 2 or more years' experience working in the Health insurance industry maintaining provider data, provider directories and/or contract management+ Intermediate in Microsoft Word and Excel+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences+ Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance for Humana systems is 10Mx1M+ We will require?full COVID vaccination for this job as we are a?healthcare?company committed to putting health and safety first for our members, patients, associates and the communities we serve.+ If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.**Preferred Qualifications**+ High School Diploma+ 3 or more years of provider relations experience OR provider loading experience+ 6+ months or more of Apex knowledge+ Provider contract interpretation experience+ Previous account management or project management+ Previous network operations experience+ Knowledge with medical claims+ Knowledge of PMDM and/or PAAG+ Knowledge of Service Fund**Additional Information**+ Travel- 5%As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviewsIn order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time.These requirements include:+ Access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m+ Dedicated secure home workspace for interview or work purposes.+ Humana continues to monitor the situation, and will adjust service levels as the corona virus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and well-being during the hiring process.**Internal only** : 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.**Scheduled Weekly Hours**40

Keywords: Humana, San Antonio , Network Operations Coordinator 4, Other , San Antonio, Texas