Network Operations Coordinator 4 at Humana (Las Vegas, NV)

| Las Vegas, NV
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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.'

#LI-BB1

Scheduled Weekly Hours

40
More Information on Humana
Humana operates in the Healthtech industry. The company is located in Louisville, KY and Chicago, IL. Humana was founded in 1961. It has 40741 total employees. It offers perks and benefits such as Flexible Spending Account (FSA), Disability Insurance, Dental Benefits, Vision Benefits, Health Insurance Benefits and Life Insurance. To see all 78 open jobs at Humana, click here.
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