Provider Network Operations Specialist - Health Plans

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

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