Provider Network Operations Lead

Verda Healthcare Inc; Huntington Beach (CA); On-site; USD 70,000 - 80,000; Full time

Benefits offered by this job

401(k)

Health insurance

Dental Insurance

Vision insurance

Life insurance

Paid time off

Job summary

Verda Healthcare, Inc in Huntington Beach, CA is seeking a Provider Services Manager to lead the daily provider services operations, ensuring timely, accurate support for contracted providers, delegated IPAs, and internal partners.

Responsibilities include onboarding, provider communications, issue escalation, data coordination with Credentialing and Provider Data Management, and collaboration with Claims, Compliance, and IT to maintain CMS compliance.

Qualifications

• Bachelor’s degree in healthcare administration, business, or related field.
• 3–5 years of experience in provider services/relations or healthcare operations, supervisory/management experience.
• Experience with CMS regulations and delegated network models preferred.

Responsibilities

• Manage the day-to-day operations of the provider Services department and serve as the primary operational resource for providers.
• Coordinate delegated IPA collaboration, issue resolution, and transitions between providers and delegated entities.
• Oversee onboarding for new IPAs and providers, and manage provider communications including newsletters and policy updates.
• Serve as escalation point for provider inquiries, resolving issues with claims, credentialing, and other internal teams.
• Organize and facilitate quarterly IPA/hospital Joint Operations Committee meetings, driving priorities and follow-ups.
• Coordinate provider data activities with Credentialing and Provider Data Management to ensure accuracy and timeliness.
• Develop and maintain SOPs and participate in improvement projects to enhance provider and member experiences.

Skills

Provider operations

Customer service

Relationship management

Analytical skills

Communication

Cross-functional collaboration

CMS regulations

Microsoft Office

Provider portals

Education

Bachelor’s degree

Healthcare experience

Tools

Provider portals

Credentialing systems

Healthcare management systems

Microsoft Office

Job description

Verda Healthcare, Inc in Huntington Beach, CA is seeking a Provider Services Manager to lead the daily provider services operations, ensuring timely, accurate support for contracted providers, delegated IPAs, and internal partners.

Responsibilities include onboarding, provider communications, issue escalation, data coordination with Credentialing and Provider Data Management, and collaboration with Claims, Compliance, and IT to maintain CMS compliance.