Provider Network Operations Representative
- Salary
- $25–$30/hr
- Hiring from
- United States
- Work type
- Hybrid
- Posted
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About the Role:
The Provider Network Operations Representative supports the day-to-day operational functions of the provider network in the OC-IE-SD markets and may assist with designated non-CA and MSO Client accounts. This role serves as a key operational liaison between providers, internal departments, and network leadership to ensure accurate network data, efficient workflows, and timely issue resolution. Reporting to the VP, Network Management , this role is execution-focused and plays a critical role in maintaining provider network integrity, supporting onboarding and maintenance activities, and ensuring compliance with health plan and regulatory requirements.
What You'll Do
Provider Network Operations & Support
- Facilitate compliance-related activities to meet health plan, DMHC, DHCS, and regulatory requirements.
- Support provider network operations including onboarding, terminations, issue resolutions, communications, credentialing, provider updates, and maintenance of department files.
- Coordinate provider-related operational activities across internal teams such as Contracting, Credentialing, Claims, and Network Management.
- Assist Network Management provider engagement functions as needed.
Provider Communication & Issue Resolution
- Intake and solution provider inquiries adhering to administrative processes.
- Track, research, and resolve operational issues timely and professionally.
- Escalate complex or systemic issues to leadership as appropriate.
Data Accuracy & Reporting
- Maintain accurate documentation of provider records, interactions, and workflows.
- Assist with audits, directory validation, and regulatory reporting requirements.
- Support preparation of reports related to provider network operations and performance.
Cross-Functional Collaboration
- Partner with Provider Network, Credentialing, Contracting, Claims, and Quality teams to support seamless network operations.
- Participate in meetings and initiatives related to network optimization and operational improvements.
- Support market-specific network initiatives as assigned.
- Coordinate with the Quality and Risk team to distribute reports and collect data from providers.
Compliance & Process Adherence
- Ensure compliance with health plan requirements, company policies, and state and federal regulations (e.g., DMHC, CMS).
- Follow established workflows and contribute to process improvements that enhance efficiency and accuracy.
- Support readiness for internal and external audits.
- Other duties as assigned.
Qualifications
- Associate or bachelor’s degree in healthcare administration, Business, or related field (or equivalent experience)
- At least 1 year of experience in provider network operations, healthcare administration, or managed care support
- Strong organizational skills with high attention to detail
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook)
You're great for the role if:
- Experience in managed care, IPA, MSO, or health plan environments
- Familiarity with provider directories and healthcare information systems
- Experience supporting operational or compliance functions
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The home office is located at 3975 Jackson St. Suite 102, Riverside, CA 92503.
- This position may require field visits to provider offices based in OC, IE, and SD regions.
- The total compensation target pay range for this role is between $25.00 - $30.00 per hour. 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 humanresourcesdept@astranahealth.com 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.
