Provider Services Manager in Huntington Beach, California at Verda Healthcare Inc

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Provider Services Manager to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc and we will support you all the way.

Position Overview

The Provider Services Manager (PSM) at Verda Healthcare is responsible for leading the daily operations of Verda Healthcare's Provider Services department, ensuring exceptional service and operational support for contracted providers, delegated Independent Practice Associations (IPAs), ancillary providers, and internal business partners.

This position oversees provider inquiry resolution, provider communications, issue escalation, provider onboarding support, provider education, delegated IPA coordination, and provider data issue management. The Manager works collaboratively across Credentialing, Provider Data Management, Claims, Network Contracting, Compliance, Information Technology, and Delegation Oversight to ensure providers receive timely, accurate, and consistent support while maintaining compliance with CMS, state regulatory, and organizational requirements.

The Provider Services Manager reports directly to the Sr. Director of Provider Network & Contracting and serves as the operational leader responsible for delivering a high-quality provider experience.

Job Description

· Manage the day-to-day operations of the provider Services department. Serve as the primary operational resource for providers regarding, claims inquiries, provider portal support, directory concerns, demographic updates, provider education, and escalated provider complaints. Coordinate with internal departments when additional research or resolution is required.

· Delegated IPA Collaboration – Develop strong working relationships with delegated IPAs by coordinating provider issue resolution, monitoring turnaround times, escalating unresolved issues, supporting provider transitions, coordinating provider demographic updates, and facilitating communication between providers and delegated entities.

· Provider Onboarding & Communications – Coordinate onboarding for new IPAs and providers; ensure timely delivery of materials, orientation sessions, and operational readiness. Oversee provider communications including, provider newsletters, operational notices, policy updates, portal announcements, educational materials, network operation changes. Ensure communications are accurate, timely, and compliant with CMS requirements.

· Provider Inquiries & Support – Serve as point of escalation for provider inquiries, resolving issues in collaboration with claims, utilization management, credentialing, and other internal teams.

· Joint Operations Committees – Organize and facilitate quarterly IPA/hospital Joint Operations Committee meetings; driving consensus on performance priorities and follow up actions.

· Provider Data Coordination – Partner with Provider Data Management and Credentialing to ensures, credentialed providers are loaded timely, provider loading validation, demographic updates, roster discrepancies are resolved directory accuracy, accurate provider display in directories and provider portals.

· Policy and Procedure Development – Develop, maintain, and implement departmental policies and standard operating procedures (SOPs).

· Projects - Participate in projects and initiatives that enhance provider and member experiences.

· Perform other duties as assigned.

Professional Competencies

• Thorough understanding of Medicare Advantage provider operations.
• Knowledge of CMS regulations and delegated network models.
• Strong understanding of provider lifecycle management.
• Excellent customer service and relationship management skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong analytical and problem-solving abilities.
• Excellent written and verbal communication skills.
• Ability to collaborate effectively across departments.
• Experience interpreting provider contracts and operational requirements.
• Proficiency with Microsoft Office Suite and healthcare management systems.

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time employment

Location: Huntington Beach, CA

Compensation Range: $70,304 – 80,000 annually

Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.

Benefits:

· 401(k)

· Paid time off (vacation, holiday, sick leave)

· Health insurance

· Dental Insurance

· Vision insurance

· Life insurance

Schedule:

· Full-time onsite (100% in-office)

· Hours of operations: 9am – 6pm

· Standard business hours Monday to Friday/weekends as needed

· Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

· Reliably commute or planning to relocate before starting work (Required)

Physical Demands:

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

*Other duties may be assigned in support of departmental goals.

• Bachelor’s degree in healthcare administration, business, or related field (or equivalent experience).
• 3–5 years of experience in provider services/relations, or healthcare operations, supervisory/management experience.
• Experience supporting Medicare Advantage plans strongly preferred.
• Experience working with delegated provider networks and Independent Practice Associations (IPAs) preferred.
• Experience with provider portals, provider data management, credentialing processes, and claims operations preferred.