Provider Network Operations Analyst

Immanuel•Omaha, NE

1d•Onsite

About The Position

Immanuel Pathways PACE® is seeking a Provider Network Operations Analyst to work at Immanuel Home Office. This role supports the Provider Network Manager through provider network administration, contract lifecycle management, Primary Care Provider credentialing, and oversight of the PACE Out-of-Network process. The analyst serves as the primary administrator for Out-of-Network requests and associated contracting activities while supporting provider network operations, contract administration, compliance monitoring, and scheduling initiatives. This position collaborates with Compliance, Legal, Finance, Operations, Scheduling, and Center leadership to ensure efficient provider network administration, regulatory compliance, and participant access to services. The role also supports and lives out Immanuel’s Mission and CHRIST Promises.

Requirements

Post high-school education is required.
Two (2) years’ experience in a higher-level administrative role, preferably in the healthcare industry, is required.
Must have a valid driver’s license, proof of insurance and have reliable means of transportation.
Agree to abide by the mission, promises, philosophy, practices, and protocols of Immanuel as well as specific community or center.
Applicants must be currently authorized to work in the United States on a full-time basis.

Nice To Haves

Bachelor’s degree in business administration or related field is preferred.
Equivalent years of experience may substitute for education requirement.
Previous business or healthcare management experience preferred.
Previous experience with contract management and analytics is preferred.
Equivalent years of education may substitute for experience requirement.

Responsibilities

Serves as the primary administrator and subject matter expert for the Out-of-Network (OON) process.
Maintains and oversees the OON workflow from request initiation through contract execution, service completion, and closure.
Maintains the OON tracking system and ensures all requests are accurately documented and monitored.
Reviews OON requests for completeness and coordinates follow-up with requestors as needed.
Provides onboarding, training, and ongoing support to designated employees responsible for initiating OON requests.
Monitors adherence to established OON workflows and identifies opportunities for process improvement.
Ensures temporary, single-case, and out-of-network agreements are appropriately closed once services are complete or no longer needed.
Collaborates with providers and internal stakeholders to facilitate timely contracting and authorization of OON services.
Provides routine updates regarding OON activity, trends, and process compliance to Sr. Provider Network Manager.
Serves as the primary resource for operational questions related to the OON process.
Develops and maintains OON workflows, tools, and reference materials to promote consistency and compliance across the organization.
Identifies opportunities to transition recurring OON services to contracted providers and escalates network needs to the Sr. Provider Network Manager.
Supports the Sr. Provider Network Manager in the administration and maintenance of the contracted provider network.
Maintains and oversees a comprehensive contract tracking system for all in-network and out-of-network provider agreements.
Coordinates contract routing, review, approval, and execution processes with internal and external stakeholders.
Conducts follow-up with providers and internal departments to facilitate timely contract completion.
Maintains contract records and supporting documentation in Contract Guardian and other designated systems.
Maintains the Provider Network Listing and ensures provider information is current and consistent across designated systems.
Assists with provider onboarding and implementation activities following contract execution.
Supports network maintenance activities and special projects as assigned.
Monitors upcoming contract expirations and assists with renewal preparation and coordination.
Ensures provider demographic, participation, and contractual information remains accurate and up to date.
Assists Scheduling Leadership with operational support activities, special projects, and process improvement initiatives.
Supports maintenance and optimization of scheduling, referral, and provider workflow processes.
Assists with referral work queue cleanup, provider maintenance activities, and scheduling-related administrative projects, as needed.
Provides cross-functional support between Scheduling, Provider Network, and Center Operations teams to ensure efficient coordination of services.
Ensures provider network, credentialing, contracting, and Out-of-Network activities comply with CMS, state, organizational, and PACE requirements.
Completes implementation audit checklists following contract execution.
Monitors compliance with established provider network, credentialing, and OON workflows and requirements.
Conducts OIG exclusion screenings for prospective contracted vendors and facilities.
Reviews and maintains documentation of CMS Preclusion List monitoring reports.
Participates in quality improvement initiatives related to provider contracting, participant access, scheduling operations, and network management.
Maintains compliance with departmental and organizational policies, procedures, and confidentiality standards.
Participates in required compliance education, training, and organizational initiatives.
Responsible for the credentialing and ongoing monitoring process of PACE Primary Care Providers.
Coordinates collection, verification, and maintenance of credentialing documentation in accordance with organizational and regulatory requirements.
Maintains credentialing records and monitors licensure, certifications, insurance coverage, and other required credentialing elements.
Ensures timely recredentialing and monitoring activities are completed.
Collaborates with internal stakeholders to support Primary Care Provider credentialing compliance and documentation requirements.
Performs other duties as required or requested.

Benefits

Medical, dental, vision, Health Savings Account (HSA), and Flexible Spending Account (FSA)
Employer Paid Life Insurance
Paid Time Off - accruing from day one of employment
Floating Holidays
Paid Holidays
8 hours of Volunteer Time Off per year
401K with employer match
Wellness Program
Employee Assistance Program
Advancement opportunities (as appropriate)
Education Assistance Program – we invest up to $5,250 per year for education assistance paid up front