Provider Network Operations Analyst HFHP

3 weeks ago


Kennedy Space Center, United States Health First Full time

POSITION SUMMARY Administer the implementation of assigned provider contracts. Perform set-up, contract database loading, and preparation of administrative documents required for core-system loading. Responsible for ensuring accuracy of loading providers in the core system through assignment of appropriate code sets and fee schedule and act as an internal liaison to resolve inquires or issues. Facilitate communications and understanding of the Health Plans networks. PRIMARY ACCOUNTABILITIES Submit complete and appropriate documentation for all new contracts and contract changes to the Configuration Department. Add and terminate new providers in the core system and complete all required documentation. If the Health Plan has initiated the termination, prepare and mail letter to Florida Office of Insurance Regulations. Maintain and update all group and/or individual provider demographic information in the core system. Actively participate in Provider Performance program improvement discussions and activities. Immediately alert management of challenges/barriers impeding successful attainment of the Provider Performance program goals. Complete projects and assignments as requested, sometimes on short notice, requiring reprioritization of workload. Participate on Health Plan committees and work groups as needed, as requested by management. Work all Provider Portal tickets and requests in a timely manner and provide appropriate follow up. Grant access to the Provider Portal and reset Provider Portal passwords. Manage Provider Portal content for the Provider Operations Department. Communicate contract terms to all appropriate departments to ensure accurate payment of claims. Understand the provider contracts, including any value-based reimbursement, to ensure the provider contracts are loaded correctly and providers will be able to perform at the highest level.



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