KY – Telecommute
Network Operations Professional 2
Work at Home Kentucky
The Network Operations Professional 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 Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Network Operations Professional 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.
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
Follows established guidelines/procedures.
Bachelor’s degree or equivalent work experience
Demonstrated expertise in financial modeling, data preparation and analysis using Excel, Access and other Microsoft applications
Prior experience managing mid to large scale projects
Strong Attention to Detail
Service Fund experience strongly desired
Previous experience in the health solutions industry
Scheduled Weekly Hours: 40
Accounting & Finance , Insurance Claims , Medical & Health , Project Management , Analyst