Network Operations Center Technician I
1Path
Network Operations Manager
OhioHealth
full-time
Posted on:
Location: Ohio • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Oversees NCQA accreditation by the National Committee for Quality Assurance and regulatory compliance; maintains oversight of NCQA credentialing policies; ensures compliance with regulatory guidelines.
- Serves as an administrator for the Network Operation Entity in the Credentialing software; field questions and evaluate permission requests for end users.
- Supports selection and implementation of credentialing software systems/enhancements; trains staff on new platforms.
- Oversee enrollment function for OH-Independent Medical Group or transferring from a TIN previously in the CIN; ensure enrollment with CIN and OhioHealth payers including Medicare/Medicaid prior to go-live.
- Coordinates CIN Membership Committee activities: CIN Medical Director Review, Provider Network Development Committee, Credentials Committee and Peer Review Committee; prepare and distribute credentialing docs, agendas/minutes.
- Provide regulatory guidance to CIN Medical Directors and follow-up on reviews.
- 40% Leadership: planning and decisions; servant leadership and collaboration with OhioHealth leadership, CVO, OH-Independent Medical Group administration, legal counsel, and other stakeholders; Population Health involvement; professional development; adaptability.
- 10% Additional Network Operations Support: optimize workflows, identify bottlenecks, implement streamlined processes, utilize data analytics to track KPIs, produce reports (e.g., Qlik, turnaround time, CI Monitoring, Eligibility).
Requirements
- Bachelor's Degree (Required)
- 5 years' experience in a healthcare setting
- Physician/advanced practice provider credentialing
- Revenue operations and provider network management
- Database management
- Team/associate accountability and conflict resolution
- Understanding of regulatory requirements (TJC and NCAQ)
- Outstanding communication skills (both written and oral)
