Description

The Network Operations Coordinator 4 maintains provider relations to support the contractor activities through data integrity management and gathering of provider data needed for service operations. Ensure contracts loaded correctly.

Responsibilities

The Network Operations Coordinator 4 manages provider data including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems.

• Facilitate provider roster reconciliation
• Constant and continuous audits of provider contract loads
• Investigation and problem solving
• Working relationship with external customers (provider, IPA, Medical groups)

Required Qualifications

• 2 or more years of Managed care experience
• Intermediate in Microsoft Word and Excel
• Valid drivers license and reliable transportation
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• 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.

Preferred Qualifications

• Provider contract interpretation experience
• Knowledge with medical claims
• Data Analytics
• Proficient in Excel
• Familiar with Nevada market

Additional Information

• Department hours- flex 7-9, 8 hours
• WAH 3 days a week and office 2 days, subject to change based on business needs

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

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

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.'

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Scheduled Weekly Hours

40