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.
The Network Operations Professional 2 manages provider data analytics and operations for health plans including but not limited to demographics, rates, and contract intent. Manages shared services that help support provider audits, provider operations, credentialing, and contract management systems. Executes process improvements for intake and manages provider perceived service failures through analytics and creation of tools. 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.
- Bachelor's degree
- 3- 5 years of provider network or related provider service experience
- Demonstrated expertise in data preparation and analysis using Excel, Access and other Microsoft applications
- Prior experience managing mid to large scale projects
- Prior experience in process improvement and/or creation of tools
- Strong Attention to Detail
- Service Fund experience desired
- Experience in financial modeling
- PMP desired
- Previous experience in the health solutions industry
Would consider WAH for a current Humana associate
Scheduled Weekly Hours40