Network Operations Specialist

Essential Duties & Responsibilities

• Verify the accuracy and completeness of provider applications, ensuring that all required documents are submitted.
• Conduct thorough background checks, license verifications, and references to ensure compliance with regulatory standards.
• Coordinate with internal departments and external agencies to obtain and update relevant provider information.
• Maintain accurate and up-to-date electronic and hard copy files of all credentialing documentation.
• Communicate with providers to address any discrepancies or missing information.
• Monitor expiring licenses and credentials, proactively initiating the renewal process to avoid any disruption in services.
• Stay up-to-date with industry regulations and requirements, ensuring compliance at all times.
• Assist in preparing for and participating in audits and regulatory reviews.
• Provide support and guidance to internal staff regarding credentialing and privileging processes.
• This position is responsible for providing supporting services, provider operations and contracting of individual and facility behavioral health providers. This position is accountable for researching and resolving provider inquiries arising from contract operations, system, and directory issues. This position is responsible for internal communications including working with Provider Network and Provider Relations team members and staff related to contract and network build initiatives and issue resolution.
• Assist the team to build a fast-paced BH provider network project with a tight deadline.

Essential Education & Experience

 At least 2 years of experience in a healthcare organization, preferably in credentialing, provider relations or provider contracting.

• Basic data-entry skills in Excel required; Microsoft Outlook required; Microsoft Word a plus
• Ability to work independently, set priorities and meet regulatory and client deadlines
• Strong attention to detail
• Team player; ability to collaborate with other internal teams as needed
• High school diploma required
• Excellent oral and written communication skills
• Provider data management experience strongly preferred
• Experience with credentialing management software preferred
• Customer service experience desirable

Working Environment

While performing the duties of this job, the employee regularly works in a home remote office near office equipment (telephone, computer).  Verbal and written communication, telephone usage, filing, sitting, typing, reading, and carrying are required to perform the essential functions of this job.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Uprise Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.