The Senior Network Operations Professional maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data 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 departments 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.
- Bachelor’s Degree
- 3 or more years of provider relations/operations experience within a health plan or hospital system
- Proficient in Microsoft Office Applications to include Word, Excel, PowerPoint, etc.
- Knowledge of medical claims data
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Master’s Degree
- Medical claims processing experience
- Strong financial analysis and reporting
- Extensive knowledge of multiple types of Current Procedural Terminology and Healthcare Common Procedure coding systems
- Project management and process mapping experience
Additional Information
Scheduled Weekly Hours
40
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Scott Smith 