Provider Network Operations Representative
About The Position
The Provider Network Operations Representative supports day-to-day provider network operations in the OC-IE-SD markets and may assist with designated non-CA and MSO Client accounts. The role serves as an operational liaison among providers, internal departments, and network leadership, helping maintain accurate network data, efficient workflows, and timely issue resolution. It is execution-focused and supports provider network integrity, onboarding and maintenance activities, and compliance with health plan and regulatory requirements. The position follows a hybrid work structure, with work both in the office and at home on a weekly basis. The home office is located at 3975 Jackson St. Suite 102, Riverside, CA 92503. Field visits to provider offices in the OC, IE, and SD regions may be required. The target pay range is $25.00–$30.00 per hour; actual compensation depends on geographic location, experience, and other job-related factors.
Requirements
- Associate or bachelor’s degree in healthcare administration, business, or a related field, or equivalent experience.
- At least 1 year of experience in provider network operations, healthcare administration, or managed care support.
- Strong organizational skills and high attention to detail.
- Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook.
Nice To Haves
- Experience in managed care, IPA, MSO, or health plan environments.
- Familiarity with provider directories and healthcare information systems.
- Experience supporting operational or compliance functions.
Responsibilities
- Facilitate compliance-related activities to meet health plan, DMHC, DHCS, and regulatory requirements.
- Support provider network operations, including onboarding, terminations, issue resolution, communications, credentialing, provider updates, and department file maintenance.
- Coordinate provider-related operational activities across Contracting, Credentialing, Claims, and Network Management.
- Assist Network Management provider engagement functions as needed.
- Intake provider inquiries and provide solutions in accordance with administrative processes.
- Track, research, and resolve operational issues in a timely and professional manner.
- Escalate complex or systemic issues to leadership as appropriate.
- Maintain accurate documentation of provider records, interactions, and workflows.
- Assist with audits, directory validation, and regulatory reporting requirements.
- Support preparation of reports related to provider network operations and performance.
- Partner with Provider Network, Credentialing, Contracting, Claims, and Quality teams to support network operations.
- Participate in meetings and initiatives related to network optimization and operational improvements.
- Support assigned market-specific network initiatives.
- Coordinate with the Quality and Risk team to distribute reports and collect data from providers.
- Follow health plan requirements, company policies, established workflows, and state and federal regulations, including DMHC and CMS requirements.
- Contribute to process improvements that enhance efficiency and accuracy.
- Support readiness for internal and external audits.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
