Specialist II, Contract Operations
New
This role is 100% remote and can sit anywhere in the Continental United States.Full-TimeMiddle
Salary22.5 - 28.5 USD per hour
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Job Details
- Experience
- Minimum 2 years of experience in high-volume research, Customer Accounts ownership or complex administrative resolution work.
- Required Skills
- Data AnalysisSalesforceSharePointMicrosoft Excel
Requirements
- High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred.
- Minimum 2 years of experience in high-volume research, Customer Accounts ownership, or complex administrative resolution.
- Proven track record of top performance in a production-based environment.
- Advanced Excel skills, including formula writing (complex IF statements, VLOOKUP, mail merge integration, conditional formatting).
- Strong proficiency in Microsoft Outlook, Word, PowerPoint, and SharePoint.
- Experience with Salesforce or database management systems preferred.
- Ability to analyze complex contract and credentialing scenarios without direct oversight.
- Strong verbal and written communication skills to distill complex issues for stakeholders.
- Capacity to manage an annual volume of 4,500 credentialing packets plus research and resolution cases.
- Resilience to handle high-pressure situations, urgent deadlines, and rapid technical or requirements changes.
Responsibilities
- Perform accurate and timely contract reviews regarding Best Demonstrated Performance language, checklists, codes, and rates.
- Independently research and resolve complex network and claims issues in collaboration with internal teams.
- Analyze root causes of delays or denials using A3 worksheet formats.
- Maintain high data integrity across systems including Orion, CLM, COR, Salesforce, and IBM-based data systems.
- Build and maintain strong professional relationships with external payor contacts.
- Provide data for weekly reports, including task categories, email volume, and escalation tracking.
- Manage high-volume workflows, prioritizing tasks by risk and value to ensure SLA compliance.
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