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Provider Grid Operations Specialist

Provider Grid Operations Specialist

Astrana Health, Inc.Monterey Park, CA, US
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Job Description

Job Description

Description

We are currently seeking a highly motivated Provider Grid Operations Specialist to support our Provider Data Management team at Astrana Health. This role will report to the Manager of Provider Data Management and will focus on validating provider data, ensuring SB-137 compliance, and serving as a key liaison between internal departments and external health plan partners. This is an exciting opportunity to contribute to high-quality, accurate provider information while supporting operational excellence at a growing company.

Our Values

  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team

What You'll Do

  • Review provider adds, terminations, and demographic update requests.
  • Validate and uphold the integrity of provider database adhering to SB-137 compliance.
  • Act as liaison between internal departments (Contracting, Credentialing, Provider Relations, Terms and Conditions, Eligibility, PDM) and external health plan entities to resolve provider inquiries and requests.
  • Maintain and update providers’ health plan unique identification numbers across all lines of business.
  • Identify provider data errors and coordinate with responsible parties to correct.
  • Accurately log all provider requests and provide monthly summaries to Manager and Team Lead.
  • Audit provider membership assignments based on Shared / Full Risk contracts and PPG codes.
  • Adhere to corporate standards for performance metrics, data integrity, and reporting.
  • Validate IPA and Health Plan Rosters.
  • Perform other duties as assigned by the Manager or Team Lead.
  • Qualifications

  • Bachelor's degree or Associate’s degree prefereed. High school diploma required.
  • Minimum 2-3 years of experience in the healthcare industry with provider, IPA, or health plan communications.
  • Knowledge of health plan lines of business in California.
  • Proficiency in Microsoft Word, Excel, and proprietary software applications.
  • Strong organizational ability and sound judgment.
  • Familiarity with basic medical terminology preferred.
  • You’re Great for This Role if You Have :

  • Experience working with provider data, insurance plans, or healthcare operations.
  • Strong communication skills with the ability to resolve inquiries professionally.
  • Ability to work both independently and collaboratively with cross-functional teams.
  • Attention to detail and commitment to accuracy.
  • A proactive and resourceful mindset with the ability to solve problems.
  • Environmental Job Requirements and Working Conditions

  • This is a full-time, on-site position located at 1600 Corporate Center Dr., Monterey Park, CA 91754. Standard office hours are Monday–Friday during business hours.
  • The total compensation target pay range for this role is $24.00 to $27.00 per hour. The salary range represents our national target range for this position.
  • Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

    Additional Information :

    The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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    Operation Specialist • Monterey Park, CA, US

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