Job Summary:

The Network Operations Specialist assists in developing and executing the strategy and performance of the provider network and network outcomes. This is a collaborative role requiring critical thinking skills, independence, leadership, a strategic mindset, and attention to detail.

Duties/Responsibilities:

· Responsible for credentialing, recredentialing and health plan enrollment of all network providers

· Performs primary source verification for initial credentialing and recredentialing

· Maintains credentialing and provider enrollment database and files, including supporting documentation

· Works closely with clinical staff to obtain data, documents, and signatures, as needed, in a timely manner

· Tracks and performs follow through with insurance plans until provider enrollment is complete and provider is in-network with the plan and linked to QMC

· Troubleshoots provider issues related to enrollment and insurance plan credentialing

· Uses credentialing and provider enrollment software and other computer programs, as applicable, effectively

· Tracks expirables and updates documentation in a timely manner.

· Remains current on all regulatory changes in the acute and post-acute care environment.

· Performs other duties and responsibilities as required, assigned, or requested.

Required Skills/Abilities:

· Ability to maintain effective interpersonal relationships

· Ability to communicate effectively in both oral and written form

· Skilled in completing assignments accurately and with attention to detail

· Ability to independently plan, organize and prioritize work.

Education and Experience:

· Bachelor’s degree in health services administration or related field preferred

· Minimum 3 years of relevant experience in health plan enrollment and/or hospital credentialing

· Experience and proficiency with general computer software (Word, Excel, PowerPoint, PDF, Outlook)

Physical Requirements:

· Prolonged periods of sitting at a desk.

· Must be able to lift up to 15 pounds at times.