Network Operations Coordinator II

Health Care Service Corporation•Houston, TX

1d•$47,500 - $86,000•Hybrid

About The Position

This Position Is Responsible For The Contracting, Credentialing, And Maintenance Of Professional Provider Data To Support Marketing, Membership And Network Contracting Across All Lines Of Business. Building Relations With The Provider Community Is An Important Part Of This Role. Responsibilities Include Promoting High Quality Initiatives To Support Data Integrity. Accepting Ownership And Leading Highly Specialized Operational And Customer Support Duties That Require Independent Initiative. This Role Includes Participating In Internal Provider Meetings And Work Groups, Researching Problems Related To Provider Credentialing, Data And Network Participation. As a part of the Provider Engagement Team, this position will work closely with providers to accelerate their transition to value-based care and to help them manage the long-term health of their patients. This position uses a consultative approach, emphasizing physician engagement, delivery system organization and culture change, actionable data and analytics, as well as patient engagement to support treatment plans. We collaborate with providers to drive change and ensure success in a value-based market. This position is also responsible for the contracting, credentialing, and maintenance of professional provider data to support marketing, membership and network contracting across all lines of business. Building relations with the provider community is an important part of this role. responsibilities include promoting high quality initiatives to support data integrity. accepting ownership and leading highly specialized operational and customer support duties that require independent initiative. This role includes participating in internal provider meetings and work groups, researching problems related to provider credentialing, data and network participation. Serves as primary contact for providers and provider staff to assist in contract management and provide supporting analyses for network and performance optimization. Develops and maintains positive relationships with physicians, providers, and practice managers within the network, including oversight and managing performance in various incentives based and/or value based programs. Provide tactical operations support to assigned groups, including contracting, data integrity, communications, and relationship management. Create and deliver materials to educate providers and provider staff on contracts, policies and procedures, quality and service line initiatives, and financial performance Prepares and delivers presentations with providers, provider staff, and/or physician leadership during monthly operational meetings. Understands, develops, tracks, monitors and reports on key program performance metrics, such as utilization, coding, and STARs/quality performance. Perform root cause analyses and resolution related to provider concerns, grievances, claims and care delivery. Assist in the STARS and clinical metrics data collection, and design plans for enhanced provider engagement in quality initiatives. Prepare materials and participate in monthly financial review with senior leadership. Partners with other internal departments, including but not limited to Health Services, Finance, Claims, and Coding in order to develop solutions for strategic business needs. Work closely with internal representative for needs and support.

Requirements

Bachelor degree OR 4 years of experience in the Health Care industry
2 years of experience with Provider Network contracting and credentialing systems
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

Subject Matter Expert for the Professional Provider Credentialing Process
Experience with Microsoft Office applications including Excel, Access, and Power Point
Previous HEDIS and/or CMS STARs experience
Solid understanding of health insurance, customer messaging/design and project management
Strong experience using Microsoft products, including Excel (knowledge of pivot tables, VLOOKUP, etc.) and PowerPoint
Experience in financial/trend analysis
Team player with proven ability to foster and manage working relationships within a matrix environment to obtain buy-in and drive results

Responsibilities

Contracting, credentialing, and maintenance of professional provider data
Building relations with the provider community
Promoting high quality initiatives to support data integrity
Leading highly specialized operational and customer support duties
Participating in internal provider meetings and work groups
Researching problems related to provider credentialing, data and network participation
Accelerating provider transition to value-based care
Helping providers manage the long-term health of their patients
Using a consultative approach emphasizing physician engagement, delivery system organization and culture change, actionable data and analytics, as well as patient engagement to support treatment plans
Collaborating with providers to drive change and ensure success in a value-based market
Serving as primary contact for providers and provider staff to assist in contract management
Providing supporting analyses for network and performance optimization
Developing and maintaining positive relationships with physicians, providers, and practice managers
Overseeing and managing performance in various incentives based and/or value based programs
Providing tactical operations support to assigned groups, including contracting, data integrity, communications, and relationship management
Creating and delivering materials to educate providers and provider staff on contracts, policies and procedures, quality and service line initiatives, and financial performance
Preparing and delivering presentations with providers, provider staff, and/or physician leadership during monthly operational meetings
Understanding, developing, tracking, monitoring and reporting on key program performance metrics, such as utilization, coding, and STARs/quality performance
Performing root cause analyses and resolution related to provider concerns, grievances, claims and care delivery
Assisting in the STARS and clinical metrics data collection
Designing plans for enhanced provider engagement in quality initiatives
Preparing materials and participating in monthly financial review with senior leadership
Partnering with other internal departments, including Health Services, Finance, Claims, and Coding in order to develop solutions for strategic business needs
Working closely with internal representatives for needs and support