Provider Network Operations

Humana

1d•Remote

About The Position

Humana Healthy Horizons is looking for a Network Operations Professional who 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 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Network Operations Professional responsibilities include (but not limited to): Manage provider data for health plans including demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Execute processes for intake and manage provider perceived service failures. Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Follow established guidelines/procedures. Use your skills to make an impact.

Requirements

Must work within the eastern standard time zone hours.
3+ years of provider network experience.
Demonstrated expertise in financial modeling, data preparation and analysis using Excel, Access and other Microsoft applications.
Experience using Structured Query Language (SQL).
Prior experience managing mid to large-scale projects.

Nice To Haves

Bachelor's degree.
Service Fund experience.
PMP or PMI-ACP certifications.
Previous experience in the health solutions industry working with large datasets and health-care data.
Experience with SAS and/or SPSS.
Intermediate to advanced experience in programming, analytical work, research and/or statistics.

Responsibilities

Manage provider data for health plans including demographics, rates, and contract intent.
Manages provider audits, provider service and relations, credentialing, and contract management systems.
Execute processes for intake and manage provider perceived service failures.
Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
Follow established guidelines/procedures.