AHN/AHNSS Operations Specialist

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Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day. Job Overview The AHN/AHNSSP Operations Specialist supports the AHN Operations and Delegated Oversight team in the execution and monitoring of delegated managed care functions, including but not limited to Claims Operations, Provider Network Management, and Credentialing. This role is responsible for monitoring audit readiness activities, tracking regulatory compliance, facilitating cross-functional submissions, and ensuring delegated operational performance aligns with contractual and regulatory standards. This position serves as a key operational liaison between internal functional teams and health plan partners, ensuring timely and accurate responses to oversight requests, audits, reporting obligations, and corrective action initiatives. The role is execution-driven, compliance-focused, and highly collaborative, with responsibility for day-to-day delegation monitoring activities. Minimum Requirements High school diploma or equivalent required; Associate's or Bachelor's degree preferred. Minimum of 3 years of experience in managed care operations (including but not limited Claims, Provider Network Management and/or Credentialing) required. Minimum 1 year of experience supporting delegation oversight, audit coordination, or regulatory compliance functions required. Strong working knowledge of CMS, California state regulations, Medicare, Medi-Cal, and Commercial managed care requirements required. Minimum 1 year of experience preparing audit documentation and corrective action plans required.

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