Provider Network Specialist (San Fernando Valley)

Department: Market Ops - APC
Location: 9700 Flair Drive, El Monte, CA 91731

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.

Responsibilities

• 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

Requirements

• 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

Preferred Qualifications

• 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

Schedule

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.

Pay

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.