Network Operations Coordinator II

About the role

This position is responsible for the contracting, credentialing, and maintenance of professional provider data to support marketing, membership, and network contracting across all lines of business. Building relationships with the provider community is a key aspect of the role. As part of the Provider Engagement Team, this position works closely with providers to accelerate their transition to value-based care and help manage the long-term health of their patients.

This role uses a consultative approach, emphasizing physician engagement, delivery system organization, culture change, actionable data and analytics, and patient engagement to support treatment plans. The position collaborates with providers to drive change and ensure success in a value-based market.

Responsibilities

• Serve as the primary contact for providers and provider staff to assist in contract management and provide supporting analyses for network and performance optimization.
• Develop and maintain positive relationships with physicians, providers, and practice managers within the network, including oversight and management of performance in various incentive-based and/or value-based programs.
• Provide tactical operations support to assigned groups, including contracting, data integrity, communications, and relationship management.
• Create and deliver materials to educate providers and provider staff on contracts, policies and procedures, quality and service line initiatives, and financial performance.
• Prepare and deliver presentations with providers, provider staff, and/or physician leadership during monthly operational meetings.
• Understand, develop, track, monitor, and report on key program performance metrics, such as utilization, coding, and STARs/quality performance.
• Perform root cause analyses and resolution related to provider concerns, grievances, claims, and care delivery.
• Assist in the STARS and clinical metrics data collection, and design plans for enhanced provider engagement in quality initiatives.
• Prepare materials and participate in monthly financial reviews with senior leadership.
• Partner with other internal departments, including Health Services, Finance, Claims, and Coding, to develop solutions for strategic business needs.
• Participate in internal provider meetings and work groups, researching problems related to provider credentialing, data, and network participation.
• Promote high-quality initiatives to support data integrity and lead highly specialized operational and customer support duties requiring independent initiative.

Requirements

• Bachelor’s degree or 4 years of experience in the healthcare industry.
• 2 years of experience with provider network contracting and credentialing systems.
• Written and verbal communication skills to interact with internal and external customers.
• Analytical and quantitative skills.
• Ability to take initiative and work independently.

Preferred Qualifications

• Subject matter expert for the professional provider credentialing process.
• Experience with Microsoft Office applications including Excel, Access, and PowerPoint.
• Previous HEDIS and/or CMS STARs experience.
• Solid understanding of health insurance, customer messaging/design, and project management.
• Strong experience using Microsoft Excel (knowledge of pivot tables, VLOOKUP, etc.) and PowerPoint.
• Experience in financial/trend analysis.
• Proven ability to foster and manage working relationships within a matrix environment to obtain buy-in and drive results.

Schedule

This is a field-based position. The individual will be onsite at provider offices 3-5 times weekly.

Pay

The salary range for this role is $47,500.00 - $86,000.00 annually. Exact compensation may vary based on skills, experience, and location. This role aligns with an annual incentive bonus plan subject to the terms and conditions of the plan.

Benefits

• Health and wellness benefits.
• 401(k) savings plan and pension plan.
• Minimum of 15 days of paid time off.
• Paid parental leave.
• Disability insurance and supplemental life insurance.
• Employee assistance program.
• Paid holidays.
• Tuition reimbursement.
• Other incentives for full-time employees.