Health Plan Provider Operations Specialist
Core
Maintain provider data and manage health plan paneling operations for the Altura network, ensuring accurate listing of providers with contracted health plans and compliance with business rules.
Role type
Health Plan Provider Operations Specialist
Builds
Provider network alignment and compliance with contracted health plans
Domain
Healthcare / Managed Care
Deliverable
dashboards & analysis
Required skills
Provider relations, Credentialing, SQL databases, Process compliance, Auditing, Contract review
Preferred skills
Managed care knowledge, Interaction with multiple health plans
Responsibilities
Monitor and validate standard paneling procedures, Act as liaison between Altura and health plans, Ensure quality of contracts initiated by Contracting department, Conduct periodic evidence-based reviews and audits of internal processes, Partner with customers to measure progress and implement process improvements