Health Plan Provider Operations Specialist

AltaMed Health Services Corporation; Montebello (CA); Hybride; USD 37 000 - 47 000; Plein temps

Avantages offerts par ce poste

Medical, Dental and Vision insurance

403(b) Retirement savings plans withem

Flexible Spending Accounts

Commuter Flexible Spending

Career Advancement & Development

Paid Time Off & Holidays

Tuition Reimbursement Program

Employee Referral Bonus Program

Pet Care Insurance

Résumé du poste

AltaMed Health Services Corporation is seeking a Health Plan Provider Operations Specialist to maintain provider data and manage paneling with health plans across the Altura network. The role focuses on accurate contracts, compliance, and process improvements.

The position requires credentialing or provider relations experience, knowledge of managed care, and SQL database usage. Hybrid collaboration with internal teams and external plans is essential.

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.

Responsabilités

• Maintain provider data and Health Plan paneling for the Altura network.
• Ensure provider listings are contracted with health plans across lines of business.
• Monitor and audit paneling processes for compliance and risk management.
• Liaise between Altura and health plans to update the Provider Network.

Connaissances

Credentialing

Provider relations

Stakeholder management

Formation

Bachelor’s degree

Outils

SQL databases

Description du poste

## Health Plan Provider Operations SpecialistApply: In Person: Montebello, CA 90640: Full time: Posted Today: JR10981**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.