AHN/AHNSS Operations Specialist

AltaMed•Montebello, CA

8d•$36 - $45

About The Position

The AHN/AHNSSP Operations Specialist supports the AHN Operations and Delegated Oversight team in the execution and monitoring of delegated managed care functions, including but not limited to Claims Operations, Provider Network Management, and Credentialing. This role is responsible for monitoring audit readiness activities, tracking regulatory compliance, facilitating cross-functional submissions, and ensuring delegated operational performance aligns with contractual and regulatory standards. This position serves as a key operational liaison between internal functional teams and health plan partners, ensuring timely and accurate responses to oversight requests, audits, reporting obligations, and corrective action initiatives. The role is execution-driven, compliance-focused, and highly collaborative, with responsibility for day-to-day delegation monitoring activities.

Requirements

High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred.
Minimum of 3 years of experience in managed care operations (including but not limited Claims, Provider Network Management and/or Credentialing) required.
Minimum 1 year of experience supporting delegation oversight, audit coordination, or regulatory compliance functions required.
Strong working knowledge of CMS, California state regulations, Medicare, Medi-Cal, and Commercial managed care requirements required.
Minimum 1 year of experience preparing audit documentation and corrective action plans required.