Sr Provider Network Operations Coordinator

About The Organization
Equality Health is an integrated, holistic, and tech-enabled healthcare delivery system focused on improving the health and wellness of diverse populations. Founded in 2015, Equality Health aims to improve access to value-based care for people who have long struggled with navigating the traditional one-size-fits-all U.S. healthcare system. The mission of the company is to provide high-quality care that improves and enhances lives regardless of race, ethnicity, age, or income.

Through its supplemental care management services and proprietary technology platform, CareEmpower, Equality Health helps managed care plans and health systems improve outcomes and lower costs for diverse populations while simultaneously facilitating the transition to risk-based accountability. Equality Health supports over 800,000 members and more than 4,000 practice sites and continues to scale rapidly.

In 2021, Equality Health partnered with General Atlantic, a leading global growth equity firm, to help drive continued expansion and fuel the next phase of growth as a leading value-based primary care network serving the Medicaid, Medicare and ACA Exchange populations. This strategic investment will enable Equality Health to pursue further geographic expansion, technological innovation and product development while furthering its mission of increasing access to care, lowering costs and improving outcomes for underserved individuals, families and communities.

About The Role
The Senior Provider Network Operations Coordinator is primarily responsible for supporting and managing the daily functions of end-to-end data entry and processing, as well as provider data management and membership alignment, to ensure the database is current, up-to-date, and accurate for Equality Health Network. Provider data management-related activities are based on health plan and contract specifications, business rules, data analysis, and entry, review of data via documents submitted, CRM, and other systems. The Senior Provider Network Operations Coordinator will utilize data sources, systems, and documents to validate that data is complete and accurate, investigate, input, and resolve data issues.

Responsibilities

• Support efforts to collect provider information and manage the provider contracting process
• Review, audit, and validate provider documentation using internal standards and external verification tools
• Monitor and track new provider participation requests through the data entry
• Ensure accurate membership alignment and PCP assignments across provider records
• Assist in training new and existing team members on operational processes, tools, and best practices
• Serve as the primary resource for team questions related to workflows, procedures, and system navigation
• Provide ongoing guidance to ensure consistent execution and understanding of departmental processes
• Collaborate with the Manager, Network Operations, to develop, organize, and optimize departmental workflows and projects
• Lead coordination and tracking of inquiries across email, phone, and department queues, ensuring timely resolution and follow-through
• Support implementation and maintenance of provider databases and systems, ensuring data integrity and operational efficiency
• Process, track, and maintain payer contract information by practice in the provider database and systems
• Assist with high-profile practice information updates in the provider database and systems
• Deliver exceptional customer service to internal and external associates
• Ensure compliance with documentation standards and follow-up protocols
• Maintain confidentiality of payer contracts and provider information
• Perform other duties as assigned

Required Education & Experience

• Associate's degree in business or a related field of study, or an equivalent combination of education and/or experience
• Minimum four (4) years of experience in a directly related position in the healthcare industry
• Proficiency with Microsoft Office suite and web-based technologies
• Demonstrated understanding of the provider of the credentialing processes
• Demonstrated understanding of value-based contracting

Highly Preferred Skills & Qualifications

• Experience with database management in a healthcare setting
• Demonstrated ability to gain acceptance and compliance from provider and staff and achieve a mutually beneficial outcome
• Able to organize and prioritize work and manage multiple priorities
• Excellent attention to detail
• Able to research and analyze data
• Able to collaborate and coach staff and colleagues
• Excellent problem-solving skills, including the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action
• Excellent verbal, written, and interpersonal communication skills
• Able to convey complex or technical information in a manner that others can understand, and able to understand and interpret complex information from others

Disclaimer:
This job description may not be inclusive of all assigned duties and responsibilities, or aspects of the job described, and may be amended at any time at the sole discretion of the employer
Equality Health
provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status.