**Description** The Network Operations Professional 2 maintains provider relations by supporting customer service activities through data integrity management and gathering of provider claims data needed for service operations of Florida Medicaid line of business. The Network Operations Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. **Responsibilities** The Network Operations Professional 2 manages provider data for Florida Medicaid including but not limited to Provider demographics, rates, contract intent, and claims data research. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **Required Qualifications** + Bachelor's degree or 3 - 5 years of provider network experience + Demonstrated expertise in data preparation and analysis using Excel, Access and other Microsoft applications + Prior experience managing mid to large scale projects + Strong Attention to Detail + 1 or more years using SQL pulling claims data + Florida Medicaid experience + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Claims Billing experience + PMP desired + Previous experience in the health solutions industry + Strong Attention to Detail + Strong communication, critical thinking, problem resolution and interpersonal skills **Additional Information** + Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) is required. + A dedicated home office space, with a locked door, lacking ongoing interruptions to protect member PHI / HIPAA information **Scheduled Weekly Hours** 40 <>
Categories
• Financial Services