Find & Apply For Scheduler / Operations Coordinator Jobs in Montebello, California

Health Plan Operations Specialist 1401 North Montebello Boulevard, Montebello, CA 90640 $26 - $30 an hour - Temporary, Full-time Apply with Indeed

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TEMPORARY ASSIGNMENT UNTIL 12/31/26

•POSSIBLE

TEMP TO HIRE OPPRTUNITY

•Position Summary Support the Managed Care Department in improving provider satisfaction and access to care across the AltaMed network. Maintain accurate provider data and oversee provider paneling operations for all applicable health plans and lines of business. Serve as a liaison between AltaMed and contracted health plans to ensure timely and accurate provider network updates. Support contract compliance, internal process reviews, audits, risk identification, and process improvement initiatives. Partner with internal stakeholders to monitor performance, identify trends, and recommend process improvements, training, and performance management solutions. Essential Duties and Responsibilities Collect and maintain provider network data, including tracking contracts through the credentialing process. Submit new provider contracts to Contracts Administration for recordkeeping and audit purposes. Coordinate with contracted health plans to ensure timely and accurate submission of provider profiles for paneling. Provide operational support to the Provider Network department regarding paneling activities. Research significant membership changes and communicate findings to leadership and health plan liaisons. Assist with administrative issues involving contracted primary care physicians, specialists, hospitals, and ancillary providers. Create, maintain, and distribute provider network rosters for internal customers. Create and validate health plan rosters to ensure network accuracy and improve Provider Listing Accuracy (PLA). Communicate new and revised policies and procedures related to contracted providers. Assist in developing evidence-based and measurable internal audit tools and performance indicators. Conduct internal administrative compliance audits and prepare aggregate data reports. Follow up with management to address non-compliance issues identified through audits and reporting activities. Develop and distribute audit and review reports to management. Assist with external audit preparation, corrective action planning, and compliance activities. Monitor corrective action plans and implement remedial measures to address challenges. Lead and participate in special projects involving process development, compliance, and training. Develop and document standard processes and workflows in collaboration with key stakeholders. Analyze processes and provide data-driven recommendations for operational improvements. Prepare and submit requested reports to leadership and supervisors. Perform other related duties as assigned. Minimum Qualifications Bachelor's degree in Business Administration, Healthcare, Organizational Management, or a related field; equivalent work experience may be considered. Master's degree preferred. At least one year of experience in member relations, claims, and/or provider relations preferred. Experience working with multiple health plans preferred. Knowledge of managed care and contracting principles preferred. At least two years of experience using MS Access or SQL databases preferred. Bilingual English/Spanish preferred. Skills and Abilities Strong written and verbal communication skills. Excellent interpersonal skills and the ability to work effectively with internal and external customers. Strong problem-solving, conflict resolution, critical thinking, and decision-making abilities. Ability to collaborate with diverse individuals and respond sensitively to the needs of special population groups. Excellent organizational, time management, and prioritization skills with the ability to manage multiple assignments. Proficiency in Microsoft Office applications, spreadsheets, file management, and healthcare software programs. Knowledge of state and federal regulations and accrediting standards applicable to medical groups and health plans. Understanding of HIPAA guidelines and PHI privacy requirements. Self-motivated, action-oriented, and able to work independently and collaboratively.

Pay:

$26.00 - $30.00 per hour Application Question(s): Do you have experience dealing with Health Insurance claims/relations? Do you have experience with interacting with multiple health plans?

Education:

Bachelor's (Required)

Experience:

SQL:

2 years (Preferred)

Microsoft Access:

2 years (Preferred)

Language:

Spanish (Preferred)

Work Location:

In person