layiq
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Montebello, CA 90640; Montebello - (1401 N Montebello Blvd)
Source: AltaMed careers · View original posting
From AltaMed's posting. “We” and “our” refer to the employer.
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
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.
LAYIQ is an independent job-discovery service. This listing does not imply a partnership with or endorsement by the employer. Review the original posting for current details and availability.
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