Network Operations Professional (Tampa, FL)
Posted on: 19 Feb 2021
Tampa, FL
Job Description
Description
The 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.
Responsibilities
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.
Required Qualifications
* Bachelor's degree
* 3 - 5 years of provider network experience (Contracting, credentialing, provider loads or related area)
* Demonstrated expertise in financial modeling, data preparation and analysis using Excel, Access and other Microsoft applications
* Prior experience managing mid to large scale projects
* Strong Attention to Detail
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences
* Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite).
Preferred Qualifications
* Service Fund experience strongly desired
* PMP desired
* Previous experience in the health solutions industry
Additional Information
Scheduled Weekly Hours
40
Humana
Louisville, KY
Humana Inc., together with its subsidiaries, operates as a health and well-being company in the United States. The company offers medical and supplemental benefit plans to individuals. It also has contract with Centers for Medicare and Medicaid Services to administer the Limited Income Newly Eligible Transition prescription drug plan program; and contracts with various states to provide Medicaid, dual eligible, and long-term support services benefits.
In addition, the company provides commercial fully-insured medical and specialty health insurance benefits comprising dental, vision, and other supplemental health and voluntary insurance benefits; financial protection products; and administrative services only products to individuals and employer groups, as well as military services, such as TRICARE South Region contract.
Further, it offers pharmacy solutions, provider services, predictive modeling and informatics services, and clinical care services, such as home health and other services to its health plan members, as well as to third parties. As of December 31, 2018, the company had approximately 17 million members in medical benefit plans, as well as approximately 6 million members in specialty products. Humana Inc. was founded in 1961 and is headquartered in Louisville, Kentucky.
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IndustryHealthcare
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No. of Employees41,600
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Website
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Jobs Posted1359
