DescriptionThe Network Operations Professional 2 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 Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Location: 4030 Boy Scout Blvd., Ste 1000 | Tampa, FL 33607 or Work from Home
The Network Operations Professional 2 manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
- Develop and maintain productive and long-term working relationships with contractors, providers and internal Humana associates.
- Utilize specialized project management methods to define the scope, logistics and documentation methods needed for various special projects.
- Analyze and manipulate financial and operational data using various modeling tools.
- Create and utilize actionable tools, reports and analyses to support Provider Network development activities.
- Investigate and resolve provider relations issues.
- High School Diploma
- Demonstrated expertise in financial modeling, data preparation and analysis using Excel, Access and other Microsoft applications
- Service Fund experience strongly desired
- Bachelor’s Degree in Finance, Management or a related business field
- Previous experience in the health solutions industry
You will report to a Manager. This area is under the leadership of the SVP & Chief Operating Officer
Scheduled Weekly Hours40