Description

The Network Operations Coordinator 4 maintains provider relations to support customer service activities through data integrity management and gathering of provider 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.

Responsibilities

The Network Operations Coordinator 4 manages provider data for health plans including but not limited to demographics, rates, and contract intent. This individual manages provider audits, provider service and relations, credentialing, and contract management systems. This individual works with the Provider Contracting Executives to assist with, and follow up on, routine provider contracts, as needed. This may include path-to-value and value-based contracts. This individual will work within broad guidelines and with little direct oversight.

• Ensures data integrity and maintenance of the contracts by performing roster audits and resolving provider load issues
• Manages initial credentialing, manages unresponsive providers through re credentialing and vendor certifications and resolves discrepancies
• Acts as a customer service liaison
• Collaborates with the Provider Engagement team to manage Value Based Relationships and manage operational issues related to data integrity with assigned providers.
• Manages delegated relationship data

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• Health Savings Accounts
• Flex Spending Accounts
• Life Insurance
• 401(k)
• PTO including 7 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
• And more

Required Qualifications

• 2+ years of previous provider experience (provider contract, provider relations, provider office, or provider customer service)
• Proficiency in Microsoft Office: Word, PowerPoint and Excel
• Analytical thinking and/or root cause analysis
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Proven track record with building and maintaining provider relationships
• Previous account management or project management
• Experience using multiple operating systems to research and manage data integrity
• Knowledge with medical claims
• 2+ years of provider relations experience
• Previous experience with auditing providers
• Experience working special projects
• Medicaid knowledge

Additional Information
Travel-5%
EST or CST working hours

Possible overtime, Hours subject to change based on business need

Location: This role will be a permanent Remote position, however, it may require minimal travel for trainings or meetings once travel restrictions are lifted.

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.

Work at Home/Remote Requirements

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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 #LI-LM1

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions to add the information into the application at Humana's secure website.

Humana is more than an equal opportunity employer, Humana's dedication to promoting diversity, multiculturalism, and inclusion is at the heart of what we do in all of our Humana roles. Diversity is more than a commitment to us, it is the foundation of what we do. We are fully focused on diversity of race, gender, sexual orientation, religion, ethnicity, national origin and all of the other fascinating characteristics that make us each uniquely wonderful.

Scheduled Weekly Hours

40