Network Operations Coordinator

Network Operations Coordinator 3

Position Overview

Become a part of our caring community and help us put health first. The Network Operations Coordinator 3 maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. This role manages provider data for health plans, including but not limited to demographics, rates, and contract intent. It also manages provider audits, provider service and relations, credentialing, and contract management systems. The coordinator executes processes for intake and manages provider perceived service failures. This position regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques. The role works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge. Use your skills to make an impact.

Employment Type

Full-time

Pay Range

$44,900 - $60,200 per year

Location Type

Remote (with occasional travel)

Requirements

• High School Diploma or equivalent
• 1+ years of prior experience in an administrative, customer support, or healthcare role
• Intermediate skills with Microsoft Word and Excel
• Ability to work in a deadline-driven environment
• Strong attention to detail
• Demonstrated ability to articulate ideas effectively in both written and oral forms

Preferred Qualifications

• Prior experience working in the healthcare insurance industry
• Previous experience in claims
• Prior contract interpretation experience

Responsibilities

• Maintain provider relations to support customer service activities
• Manage data integrity and gather provider claims data for service operations
• Manage provider data for health plans (demographics, rates, contract intent)
• Manage provider audits, provider service and relations, credentialing, and contract management systems
• Execute processes for intake and manage provider perceived service failures
• Prioritize requests and interpret/adapt procedures, processes, and techniques

Additional Information

• Travel: Occasional travel to Humana's offices for training or meetings may be required, dependent upon business needs (up to discretion of leader).
• Interviewing Technology: HireVue will be used as part of the hiring process.
• Work At Home / Internet Information:
  • Recommended download speed: 25 Mbps; upload speed: 10 Mbps.
  • Wired cable or DSL connection is suggested.
  • Satellite, cellular, and microwave connections may be used only if approved by leadership.
  • Employees in California, Illinois, Montana, or South Dakota will be provided a bi-weekly internet expense payment.
  • Humana will provide appropriate telephone equipment.
  • Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• SSN Information: Applicants may be asked to provide their Social Security Number. If required, an email will be sent from Humana@myworkday.com with instructions.

Company Information

Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family.