Health Plan Provider Operations Specialist

AltaMed Health Services; Los Angeles (CA); On-site; USD 37,000 - 47,000; Full time

Benefits offered by this job

Medical, Dental and Vision insurance

403(b) Retirement savings plans withem

Flexible Spending Accounts

Commuter Flexible Spending

Career Advancement & Development

Paid Time Off & Holidays

Paid CME Days

Malpractice insurance and tailcoverage

Tuition Reimbursement Program

Corporate Employee Discounts

Employee Referral Bonus Program

Pet Care Insurance

Job summary

AltaMed Health Services is seeking a Health Plan Provider Operations Specialist in Montebello, CA to maintain provider data and manage health plan paneling across the Altura network. The role acts as a liaison between AltaMed and health plans, ensuring accurate provider listings and contract compliance across multiple lines of business.

The candidate should have at least 1 year of credentialing/provider relations experience, 1 year of health plan interactions, and 2 years of SQL experience, with

Qualifications

• Bachelor's degree preferred, or relevant work experience required.
• Minimum of 1 year of credentialing and/or provider relations experience required.
• Minimum of 1 year of interaction with multiple health plans preferred.
• Minimum of 2 years of experience using SQL databases preferred.
• Knowledge of managed care preferred.

Responsibilities

• Maintain provider data across the Altura network and health plan panels.
• Coordinate with health plans to ensure providers are listed with all applicable plans and lines of business.
• Monitor, validate, and implement standard paneling procedures to align with organizational goals.
• Ensure quality and compliance of contracts initiated by Contracting and support risk identification and audits.

Skills

Credentialing experience

Provider relations

SQL databases

Health plan interaction

Managed care knowledge

Education

Bachelor's degree or relevant work experience

Job description

Position Title

Health Plan Provider Operations Specialist

Location

Montebello, CA 90640

Description

Grow Healthy

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day.

Job Overview

This Specialist, Health Plan Provider Operations position is responsible for the maintenance of provider data as well as Health Plan paneling operations for the entire Altura network. The Health Plan Provider Operations Specialist will ensure providers are listed accurately with all applicable contracted health plans and across all applicable lines of business. This individual will monitor, assess, validate, and implement standard paneling procedures to ensure health plan alignment with organizational goals. The position acts as a liaison between Altura and health plans to ensure changes are made to the Provider Network. In addition, the individual is responsible for ensuring the quality of contracts initiated by the Contracting department to ensure compliance and that business rules are met. Focusing on program and process compliance, this position will ensure regular, periodic evidence-based reviews and audits of internal processes and will assist with identifying potential risk areas. Partners with multiple internal /external customers to measure progress against goals, identify trends, implement process improvements, and make recommendations for required training or performance management.

Minimum Requirements

• Bachelor's degree preferred, or relevant work experience required.
• Minimum of 1 year of credentialing and/or provider relations experience required.
• Minimum of 1 year of interaction with multiple health plans preferred.
• Minimum of 2 years of experience using SQL databases preferred.
• Knowledge of managed care preferred.

Compensation

$26.91 - $33.53 hourly

Compensation Disclaimer

Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.

Benefits & Career Development

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance

Job Advertisement & Application Compliance Statement

AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

Remote Type

In Person

About US

As the nation's largest Federally Qualified Health Center (FQHC), AltaMed is at the forefront of providing affordable, high-quality health care to underserved communities in Los Angeles and Orange Counties. At AltaMed, you will have the opportunity to work with a diverse team of dedicated professionals who are passionate about making a difference and supporting our community of over 400,000 patients.

Learn About AltaMed

Click Here

AltaMed Health Services Corporation is committed to providing equal employment opportunities for all qualified individuals. We strictly prohibit discrimination in employment based on race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin, age, medical condition, physical or mental disability, military or protected veteran status, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical conditions, genetic information, or any other characteristic protected by local, state, or federal law, ordinance, or regulation.

We are committed to promoting equality and inclusivity beyond our recruitment and hiring processes. We aim to create a respectful, valued, and inclusive workplace through training, advancement opportunities, and access to resources and support. We focus on fostering a diverse workforce because it enriches our organization and improves our ability to effectively serve our clients and community. We encourage individuals from all backgrounds to apply and join us in our mission to create a positive impact.

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