Company name
Humana Inc.
Location
Bridgeport, CT, United States
Employment Type
Full-Time
Industry
Work At Home
Posted on
Mar 06, 2021
Profile
Description
The Network Operations Coordinator contributes to the provider experience by managing the accuracy of the provider data within the health plan networks. The Network Operations Coordinator 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.
Responsibilities
The Network Operations Coordinator (NOC) 4 is an important part of the regional Provider Development team and is accountable for maintaining accurate data for assigned providers. This may include path-to-value and value-based contracts. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight.
Working with provider data, provider directories, and/or contract management
Conducts audits, manages credentialing and a variety of other network management projects
Works within several complex provider data management systems and maintains proficiency with basic Office, and internal applications required to perform job duties
Collaborates with contractors, and other functional areas to problem solve and otherwise ensure a positive provider and member experience
Ensures data integrity and maintenance of the contracts including but not limited to demographics, rates and contract intent
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 and maintenance
Ensures initial credentialing, managing unresponsive providers through re credentialing, and resolves discrepancies
Manages operations issues related to data integrity with assigned providers
Required Qualifications
High School Diploma
2 years experience working with provider data, provider directories, and/or contract management
Intermediate in Microsoft Excel
Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills including ability to learn new computer programs
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
Preferred Qualifications
Bachelor's Degree
2 years of provider relations experience OR provider loading experience
6 months of Apex knowledge
Provider contract interpretation experience
Previous account management or project management
Previous network operations experience
Knowledge with medical claims
Knowledge of PMDM, PAAG and CAS
Knowledge of Service Fund
Additional Information
Work at Home New York is preferred but additional locations will be considered.
Our Hiring Process
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 interviews
If you have additional questions regarding this role posting and are an Internal Candidate, 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.
In 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 (satellite and/or wireless internet connections are NOT permitted for Work at Home roles) and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus 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 wellbeing during the hiring process. #ThriveTogether #WorkAtHome
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com