Health Plan Provider Operations Specialist

AltaMed Health Services Corporation; 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 withem

Flexible Spending Accounts

Commuter Flexible Spending

Career Advancement & Development

Paid Time Off & Holidays

Paid CME Days

Malpractice insurance and tail

Tuition Reimbursement Program

Corporate Employee Discounts

Employee Referral Bonus Program

Pet Care Insurance

Job summary

AltaMed Health Services Corporation is seeking a Health Plan Provider Operations Specialist to maintain provider data and manage paneling across the Altura network. You will ensure providers are listed with contracted plans and align paneling with organizational goals.

You will monitor processes, validate contracts, and coordinate with internal teams and health plans to improve compliance, quality, and training.

Qualifications

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

Responsibilities

• Maintain provider data and Health Plan paneling operations for the Altura network.
• Monitor, assess, validate, and implement standard paneling procedures to align with organizational goals.
• Serve as liaison between AltaMed and health plans to update the Provider Network.
• Ensure quality of contracts from the Contracting department for compliance and business rules.
• Assist with regular reviews/audits, identify risks, and suggest training or performance improvements.

Skills

Credentialing

Provider relations

Health plan interaction

Managed care knowledge

Data governance

Education

Bachelor’s degree or equivalent work experience

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.