Provider Operations Coordinator, Tampa Florida

Humana Inc. Tampa , FL 33602

Posted 7 days ago

Description

The Network Operations Coordinator 2 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 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The Network Operations Coordinator 2 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. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

  • Analyzes data and reports to identify trends, operational issues and financial impact of implemented initiatives. Serves as liaison between department and business partners, both internal and external. Identifies, evaluates, recommends and implements data-driven process improvement initiatives. Provide support on tasks and special functions such as quality reviews, root cause analysis, operational processes, etc. Collaborates with internal cross-functional team to support provider performance and resolve barriers and challenges, Drives improvement of provider performance by analyzing, interpreting, communicating utilization and quality metrics. Responsible for developing and executing performance improvement plans. Focus to maintain provider data integrity. Partners with Network Development to identify network gaps to ensure network adequacy.

Required Qualifications

  • High School Diploma or equivalent

  • 1 year+ Healthcare experience working front office, back office in a primary office or medical facility environment working with Providers.

  • Intermediate experience with MS Office to include Word, Excel and PowerPoint

  • Minimum 3 years experience using troubleshooting program or system errors

Preferred Qualifications

  • Provider relations, and/or provider contracting

  • Working knowledge of provider demographic credentialing process

  • Working Knowledge of Florida Medicaid provider Requirements

  • Provider Operations Account Management or Relevant Experience with demonstrated ability to perform the duties of the position.

  • Internal system experience with the following PPG, APEX, CIS, CAS, Physician Finder

  • Ability to facilitate meetings

  • Medical Claims Processing experience

Additional Information:

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews

Scheduled Weekly Hours
40


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Provider Operations Coordinator, Tampa Florida

Humana Inc.