Provider Relations Specialist 3

1 week ago

Dover, Delaware, United States Humana Full time

Join a dedicated community focused on prioritizing health

The Network Operations Coordinator 3 is responsible for maintaining relationships with providers to enhance customer service through effective data management and collection of provider claims information essential for operational services. This role involves executing advanced administrative, operational, and customer support tasks that necessitate independent initiative and sound judgment. The Coordinator will collaborate closely with market contractors and provider groups.

The Network Operations Coordinator 3 oversees provider information, including but not limited to demographics, payment rates, and contract intentions. This position also manages provider audits, service relations, credentialing, and contract management systems. Responsibilities include executing processes for intake and addressing perceived service failures from providers. Decisions primarily revolve around methods, tactics, and processes for completing administrative tasks and projects. The Coordinator regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques, operating under limited guidance due to extensive experience and knowledge of administrative processes and organizational dynamics.

Utilize your expertise to create a positive impact

Essential Qualifications

  • Experience in an administrative or customer support capacity within a healthcare organization
  • Able to thrive in a deadline-oriented environment
  • Experience managing special projects related to contracting and demographics
  • Intermediate proficiency in Excel, including skills in rosters, pivot tables, and Vlookup

Preferred Qualifications

  • Familiarity with research in PMDM and PAAG
  • Experience with APEX submissions
  • Knowledge of CRM systems
  • Experience with the DCAV process
  • Prior experience in claims processing
  • Experience interpreting contracts

Additional Information

This position is designated as remote/work from home and can be based anywhere in the United States, with a requirement to work during EST hours.

Remote Work Requirements

To ensure effective work capabilities for Home or Hybrid Home/Office employees, the self-provided internet service must meet the following criteria:

  • A minimum download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; a wired cable or DSL connection is preferred
  • Satellite, cellular, and microwave connections may be used only with leadership approval
  • Employees residing and working from home in specific states will receive a bi-weekly internet expense reimbursement
  • Humana will supply Home or Hybrid Home/Office employees with necessary telephone equipment to meet business requirements
  • Work must be conducted from a dedicated space free from interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Compensation Range

The compensation range below reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The pay range may vary based on geographic location and individual pay will depend on demonstrated job-related skills, knowledge, experience, education, certifications, etc. $40,200 - $55,200 per year

Benefits Overview

Humana, Inc. and its affiliated subsidiaries offer competitive benefits designed to support holistic well-being. Associate benefits aim to promote personal wellness and informed healthcare decisions for you and your family, recognizing that life extends beyond work. Among the benefits provided, Humana offers medical, dental, and vision coverage, a 401(k) retirement savings plan, paid time off (including personal holidays, volunteer time off, and paid parental leave), short-term and long-term disability, life insurance, and various other opportunities.

About Humana

Humana Inc. is dedicated to prioritizing health for our teammates, customers, and the organization. Through our insurance services and healthcare offerings, we facilitate access to the care and services needed for individuals to achieve optimal health, enhancing the quality of life for diverse populations including those with Medicare, Medicaid, families, individuals, military personnel, and broader communities.

Equal Opportunity Employer

Humana is committed to ensuring equal employment opportunities for all employees and applicants, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. Humana actively takes steps to employ and advance all individuals based on valid job requirements.

Humana adheres to all applicable federal civil rights laws and does not discriminate based on race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. We also provide free language interpreter services.

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