Humana

About Humana

 

Job Category:

Market Strategy - Operations

Country:

United States

Postal Code:

23058

Approximate Salary:

Not Specified

Position Type:

Full Time

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Network Operations Coordinator

Humana - Glen Allen, Virginia

Posted: 09/8/2018

Description

The Network Operations Coordinator 4 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 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.

Responsibilities

Manage the end-to-end setup of complex provider contracts to include IDS, Specialists, and key Providers.

.  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, maintenance (including annual escalators) attributions and contract clarifications for more complex contracts. This may include path-to-value and value-based contracts.
  • Support and communicate with Humana’s providers and internal stakeholders to facilitate greater understanding and cooperation through the course of the provider relationship.
  • Maintains contracts, including making changes and updates using various systems i.e. network add and deletes.  Collaborates with Provider Engagement Executive or Senior Provider Engagement Professional  to complete reassignment of membership.
    • Responsible for tracking and communicating progress of these changes with internal and external stakeholders and, in addition, auditing the results of the changes to ensure the intent implemented.
  • Ensures initial credentialing, managing unresponsive providers through re credentialing, and resolves discrepancies.
  • Test contract performance before operationalizing and perform audits to optimal standards for prevention. May lead/oversee testing and/or auditing of contracts by other associates.
  • Complete system set up for delegation of credentialing and any provider network data needed for other forms of delegation. Manage delegated relationship data: credentialing, UM, claims.
  • Manage operational issues related to data integrity with assigned providers Work with Contract Directors to assist with and follow up on routine provider contracts, as needed.

               

Required Qualifications

  • High School Diploma or equivalent
  • Proficiency in MS Office applications
  • Possess a strong attention to detail
  • Ability to work in a deadline driven environment
  • Strong verbal and written communication skills
  • 2 + years of provider relations experience
  • Intermediate in Microsoft Word and Excel
  • Valid drivers license and reliable transportation

Preferred Qualifications

  • Provider contract interpretation experience
  • Previous account management or project management
  • Knowledge with medical claims
  • Associate’s or Bachelor’s Degree
  • Prior experience working in the insurance industry
  • Proficiency in MS Access
  • Previous experience in claims
  • Previous provider experience (provider contract, provider relations, or provider service)


Additional Information

This position reports to a Contracting Director.

Scheduled Weekly Hours

40

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