Provider Network Specialist

Astrana Health, Inc. • El Monte, CA

2d • $70,304 - $80,000 • Hybrid

About The Position

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.

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

Nice To Haves

• 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

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
• Assist with 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
• Assist 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
• Assist with documentation, reporting, and corrective action support related to delegated functions
• 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
• 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

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level