Network Operations Coordinator

The Network Operations Coordinator 4 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 Coordinator 4 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. Ensure data integrity and maintenance of the contracts. Works within broad guidelines with little oversight. Ensures contracts are operationalized from contracting through implementation, leveraging standardized tools and quality processes end to end. Defined point of contact for Contracting and Provider Service (DCAV, PPG, Credentialing, Service Fund) regarding contract administration, data integrity, testing/auditing, maintenance (including annual escalators) attributions and contract clarifications for more complex contracts. This may include path-to-value and value-based contracts. Utilizes APEX, CAS, and PMDM systems. Maintains contracts, including making changes and updates using various systems i.e. network add and deletes. Collaborates with Provider Engagement Executive or Senior Provider Engagement Professional to complete reassignment of membership. Ensures initial credentialing, managing unresponsive providers through re credentialing, and resolves discrepancies. Manage operational issues related to data integrity with assigned providers. Work with Contract Directors to assist with and follow up on routine provider contracts, as needed.