Provider Network Specialist (San Fernando Valley)

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.

Responsibilities

• 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
• Aid in 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
• Aid 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
• Aid in documentation, reporting, and corrective action support related to delegated functions

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

You're 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: $70,304 - $80,000. 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.