The Senior Network Operations Professional maintains provider relations to support provider contracting and provider relations shared-services through data integrity management and gathering of provider claims data, process improvement, project management and analytics needed for service operations. The Senior Network Operations Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Network Operations Professional 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. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
3-5 years of provider relations, provider contracting or provider operations experience
Intermediate to advanced Microsoft Word, PowerPoint, and Excel (manipulate and present large amounts of data - slicers, pivot tables, sorting, vlookups, formulas) skills
Project management and process improvement and mapping experience
Knowledge of claims data and integrity management
Knowledge of multiple types of Current Procedural Terminology and Healthcare Common Procedure coding systems
Scheduled Weekly Hours
Equal Opportunity Employer
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