Provider Network Specialist

What You'll Do

• 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 

• 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 

• 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 

• 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 

• 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 

• 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

• Bachelor’s 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 

• 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 total compensation target pay range for this role is: $70,304  - $80,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.