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
The Health Plan Provider Operations Specialist is a key member of the Managed Care Department that aims to improve provider satisfaction and access to care. This position is responsible for the maintenance of provider data as well as paneling operations for the entire AltaMed network. The Health Plan Provider Operations Specialist will ensure providers are listed accurately in all 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 to organizational goals. The position acts as a liaison between AltaMed and health plans to ensure changes are made to the Provider Network. In addition, the individual is responsible for ensuring quality of contracts initiated by the Contracting department in order to ensure compliance and that business rules are constantly 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 customers to measure progress against goals, identify trends, implement process improvements and make recommendations for required training or performance management.
Minimum Requirements
1. Bachelor's degree in Business Administration, healthcare, organizational management or equivalent work experience required.
2. Master's degree preferred. A minimum of one year of member relations, claims, and/or provider relations experience preferred. Knowledge of managed care and contracting principles preferred.
3. Bilingual English/Spanish preferred.
4. A minimum of one year of interaction with multiple health plans preferred.
5. A minimum of two years of experience using MS Access or SQL databases preferred
Compensation
$26.13 - $32.55 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.
