Network Operations Coordinator I

Health Care Service Corporation•Richardson, TX

7d•$40,500 - $72,500•Hybrid

About The Position

This position is responsible for contracting, credentialing, and maintaining Professional Provider Data to support Marketing, Membership, and Network Contracting across all lines of business. The role administers provider contracts, rosters, and requests accurately and promptly, supporting quality initiatives and provider data accuracy. It also participates in internal provider meetings and work groups, researches issues related to provider credentialing, data, and network participation, and serves as a liaison between Network Contracting and Provider Data Management for credentialing and network activities.

Requirements

Two years of college or two years of experience.
Written and verbal communication skills to interact with internal and external customers.
Analytical and quantitative skills.
Ability to take initiative and work independently.

Nice To Haves

Experience working directly with healthcare providers and provider offices to obtain information, resolve issues, and support business operations.
One year of experience on the Premier Provider Data systems.
Existing knowledge of Professional Provider Credentialing processes.
Experience supporting Affordable Care Act (ACA) Risk Adjustment Data Validation (RADV) activities, medical record retrieval, audit support, or related initiatives.
Claims processing, claims research, or claims resolution experience within a healthcare or health plan environment.
Strong investigative and problem-solving skills, including researching discrepancies, gathering information, and driving issues to resolution.
Experience working in a high-volume call center or customer service environment, preferably handling provider- or claims-related inquiries.
Ability to work independently, take initiative, and effectively manage a high-volume workload with minimal supervision.

Responsibilities

Administer provider contracts, rosters, and requests accurately and in a timely manner.
Support quality initiatives and ensure provider data accuracy.
Participate in internal provider meetings and work groups.
Research problems related to provider credentialing, data, and network participation.
Serve as a liaison between Network Contracting and Provider Data Management for credentialing and network activities.