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Provider Network Operations Representative
Astrana Health. Facilitate compliance-related activities to meet health plan, DMHC, DHCS, and regulatory requirements .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider network operations, compliance activities, and healthcare administration, with a strong focus on regulatory requirements and operational efficiency. Proficient in managing provider relationships and supporting audit readiness while ensuring adherence to health plan policies.
Highest-signal resume keywords
Provider Network OperationsHealthcare AdministrationRegulatory ComplianceMicrosoft Office SuiteOperational Improvement
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Provider CredentialingOperational Issue ResolutionData TrackingAudit SupportDirectory Validation
Soft Skills
Strong Organizational SkillsAttention to Detail
Tools & Technologies
Healthcare Information Systems
Industry Keywords
Managed CareHealth PlanIPAMSODMHCDHCS
About the role
Key responsibilities & impact- Facilitate compliance-related activities to meet health plan, DMHC, DHCS, and regulatory requirements
- Support provider network operations including onboarding, terminations, issue resolutions, 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
- Intake, research, track, and resolve provider inquiries and operational issues
- Escalate complex or systemic issues to leadership
- Maintain accurate provider records, interaction documentation, and workflows
- Assist with audits, directory validation, and regulatory reporting
- Support provider network operations and performance reports
- Partner with Provider Network, Credentialing, Contracting, Claims, and Quality teams
- Participate in network optimization and operational improvement initiatives
- Support market-specific network initiatives
- Coordinate with Quality and Risk to distribute reports and collect provider data
- Ensure compliance with health plan requirements, company policies, and state and federal regulations
- Follow workflows and contribute to process improvements
- Support internal and external audit readiness
- Perform other duties as assigned
Requirements
What you’ll need- Associate or bachelor’s degree in healthcare administration, Business, or related field (or equivalent experience)
- At least 1 year of experience in provider network operations, healthcare administration, or managed care support
- Strong organizational skills with high attention to detail
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook)
- Experience in managed care, IPA, MSO, or health plan environments
- Familiarity with provider directories and healthcare information systems
- Experience supporting operational or compliance functions
Benefits
Comp & perks- Hybrid work structure with work both in office and at home on a weekly basis
- Field visits to provider offices in OC, IE, and SD regions may be required
- Equal Employment Opportunity and Affirmative Action Employer
- Reasonable application accommodations for disabilities