Health Plan Provider Operations Specialist

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.

Responsibilities

Maintain provider data; Ensure providers are listed accurately with all applicable contracted health plans and across all applicable lines of business; Monitor, assess, validate, and implement standard paneling procedures to ensure health plan alignment with organizational goals; Act as a liaison between Altura and health plans to ensure changes are made to the Provider Network; Ensure the quality of contracts initiated by the Contracting department to ensure compliance and that business rules are met; Ensure regular, periodic evidence-based reviews and audits of internal processes and assist with identifying potential risk areas; Partner with multiple internal/external customers to measure progress against goals, identify trends, implement process improvements, and make recommendations for required training or performance management

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

Benefits

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; Discretionary bonuses or incentives may apply