Humana Senior Network Operations Professional in Tampa, Florida

Description

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.

Responsibilities

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.

Required Qualifications

  • Bachelor's degree

  • 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

Preferred Qualifications

  • Master's Degree

  • Knowledge of claims data and integrity management

  • Knowledge of multiple types of Current Procedural Terminology and Healthcare Common Procedure coding systems

  • PMP

Scheduled Weekly Hours

40

About Us

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.