Health Plan Provider Operations Specialist

AltaMed Health Services Corp; Montebello (CA); On-site; USD 37,000 - 46,000; Full time

Benefits offered by this job

Medical, Dental and Vision insurance

403(b)

Retirement savings plans with employer

Flexible Spending Accounts

Paid Time Off & Holidays

Paid CME Days

Tuition Reimbursement

Employee Discounts

Pet Care Insurance

Job summary

AltaMed Health Services Corp. is seeking a Health Plan Provider Operations Specialist in California to maintain provider data and manage Health Plan paneling across the Altura network.

You will ensure contracted providers are listed correctly, coordinate with health plans, and help ensure compliant contracts and solid business rules. The role partners with internal and external customers, supporting audits and process improvements to drive accurate network performance.

Qualifications

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

Responsibilities

• Maintain provider data and Health Plan paneling for the Altura network.
• Act as liaison between AltaMed/Altura and health plans to update networks.
• Ensure contracts via Contracting align with business rules and compliance.
• Support audits, reviews, and process improvements across provider operations.

Skills

Credentialing

Provider relations

SQL databases

Managed care knowledge

Education

Bachelor’s degree preferred

Relevant work experience accepted

Tools

SQL databases

Job 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.

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.