Network Operations Coordinator 3- Kansas City MO Preferred/WAH WI KS MO

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Description

The Network Operations Coordinator 3 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 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment.

Responsibilities

The Network Operations Coordinator 3 manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are typically focused on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

Typical responsibilities, but not limited to:

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, and maintenance

Maintains contracts, including making changes and updates using various systems i.e. network add and deletes.

Ensures initial credentialing, managing unresponsive providers through re credentialing, and resolves discrepancies.

Manage operational issues related to data integrity with providers.

Required Qualifications

High School Diploma or equivalent

1 years of prior experience in an administrative, customer support, or related experience

Intermediate skills with Microsoft Word and Excel

Ability to work in a deadline driven environment

Strong attention to detail

Strong written and verbal communication skills

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

Prior experience working in the healthcare insurance industry

Previous experience in claims

Prior contract interpretation experience

Additional Information

Travel to Market Office monthly, quarterly or yearly dependent upon meetings, business needs (up to discretion of leader)

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com