Provider Network Specialist (San Fernando Valley)
Job Location:
Job Location:
El Monte, CA - USA
Yearly Salary:
USD 70304 - 80000
Yearly Salary:
Posted on:
25 days ago
Posted on:
Vacancies:
1 Vacancy
Vacancies:
Job Summary
About the Role:
The Provider Network Specialist supports the operational execution and day-to-day management of the provider network across the Los Angeles market. This role is responsible for coordinating provider lifecycle activities supporting network performance initiatives and serving as a key operational liaison between providers and internal departments. The Provider Network Specialist plays a critical role in ensuring provider data accuracy network access compliance and provider satisfaction while supporting membership growth and quality outcomes.
The Provider Network Specialist supports the operational execution and day-to-day management of the provider network across the Los Angeles market. This role is responsible for coordinating provider lifecycle activities supporting network performance initiatives and serving as a key operational liaison between providers and internal departments. The Provider Network Specialist plays a critical role in ensuring provider data accuracy network access compliance and provider satisfaction while supporting membership growth and quality outcomes.
What Youll Do
Provider Lifecycle & Network Operations
- Support provider onboarding terminations and updates in coordination with Contracting Credentialing and Network Operations
- Maintain accurate provider demographic specialty and participation data across internal systems and health plan files
- Assist with network configuration provider assignments and panel management activities
- Monitor onboarding timelines and follow up on outstanding requirements
Provider Support & Issue Resolution
- Serve as a point of contact for provider operational questions related to network participation assignments and system setup
- Research and resolve provider issues related to data accuracy claims routing eligibility and access
- Escalate complex or systemic issues to the Sr. Manager Provider Network as appropriate
Network Performance & Access Support
- Assist in monitoring network adequacy access standards and provider coverage requirements
- Support initiatives to improve member access reduce provider friction and enhance network stability
- Support implementation of network changes driven by growth initiatives acquisitions or health plan requirements
Provider Performance & Quality Support
- Support provider performance related to quality measures utilization and value-based care initiatives
- Collaborate with Quality Medical Management and Analytics teams to reinforce quality programs incentive alignment and performance improvement efforts
- Assist in driving improvement in key metrics such as HEDIS STARS utilization management and member experience
Compliance & Regulatory Support
- Ensure provider data and network activities comply with applicable federal state and health plan requirements (CMS DMHC DHS)
- Support provider directory accuracy efforts and regulatory audits
- Assist with documentation reporting and corrective action support related to delegated functions Cross-Functional Collaboration
- Work closely with Provider Relations Contracting Credentialing Claims Quality Medical Management and Customer Service teams
- Ensure timely and accurate communication across departments to support provider and member experience
- Support standardized workflows policies and best operational practices
Reporting & Administrative Support
- Assist with preparation of network reports dashboards and performance metrics
- Track and follow up on provider-related action items and operational deliverables
- Maintain documentation and records to support operational and audit readiness
- Other duties as assigned
Qualifications
- Bachelors degree in Healthcare Administration Business or related field (or equivalent experience)
- At least 3 years of experience in provider network operations managed care credentialing or healthcare administration
- Experience working with provider data healthcare systems and operational workflows
- Strong attention to detail and organizational skills
Youre great for the role if:
- Experience in California managed care or IPA environments
- Familiarity with CMS and DMHC requirements related to provider networks and directories
- Experience supporting network expansion or provider onboarding initiatives
Environmental Job Requirements and Working Conditions
- Our organization follows a regional/hybrid work structure where the expectation is to work both in office and visiting provider offices on a weekly basis. The office is located at 9700 Flair Drive El Monte CA 91731.
- The provider territory for this position is the San Fernando Valley.
- The total compensation target pay range for this role is: $70304 - $80000. Actual compensation will be determined based on geographic location (current or future) experience and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action Employer. We do not discriminate based upon race religion color national origin gender (including pregnancy childbirth or related medical conditions) sexual orientation gender identity gender expression age status as a protected veteran status as an individual with a disability or other applicable legally protected characteristics. All employment is decided on the basis of qualifications merit and business need. If you require assistance in applying for open positions due to a disability please email us at to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Required Experience:
IC
