Network Operations Coordinator 4/Auditor - Remote

Overview

The Network Operations Coordinator 4/Auditor maintains provider relations and supports customer service activities through data integrity management and gathering of provider claims data needed for service operations.

In Short

• Manage provider data including demographics, rates, and contract intent.
• Conduct provider audits and manage provider service relations.
• Execute processes for intake and manage provider perceived service failures.
• Audit provider data and submit findings into APEX.
• Communicate with providers and contractors via phone and email.
• Work remotely while adhering to EST hours.
• Utilize Microsoft Excel for data management tasks.
• Assist in maintaining provider contracts and data.
• Support account management and project management tasks.
• Ensure compliance with HIPAA regulations.

Requirements

• 2+ years of provider relations experience.
• 1+ years of experience with APEX, PAAG, and PMDM.
• Intermediate experience with Microsoft Word and Excel.
• Ability to work independently and manage workload.
• Experience with medical claims is preferred.
• Knowledge of provider contracts and data maintenance.
• Experience in account management or project management is a plus.
• Willingness to travel occasionally for training or meetings.
• Must have a dedicated workspace to protect member PHI.
• Must meet internet service requirements for remote work.

Benefits

• Competitive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability coverage.
• Life insurance and other opportunities for personal wellness.