Provider Demographic Mgmt Coordinator

Supports the Manager, Provider Network Ops to ensure all Boeing plan partner changes are accurately updated in ECHO and various databases. Supports the Manager of Provider Relations with the maintenance of ACO rosters and ensures daily changes are accurately updated within internal systems e.g.

Our Client, a Healthcare company, is looking for a Provider Demographic Mgmt Coordinator for their Fountain Valley, CA location.
 
Responsibilities:

• Assist Directory Support Specialist with maintaining departmental matrixes and provider rosters.
• Verify Health Plan directories and websites to ensure accuracy of provider information. Responsible for the provider demographic verification and validation of Health Plan rosters.
• Assist other departments with health plan related problems, requests and questions related to provider information.
• Responsible for assisting with the timely submission of Health Plan Adds, Changes, Terms, and semiannual and quarterly reports.
• Catalogs and tracks all changes and ensures key updates are completed in accordance to established process flows.
• Responsible for generating Health Plan notifications related Plan Adds, Changes, Terms etc. Ensures all the supporting documents are provided (e.g. W9s, Profiles, original notification request, etc.).
• Supports the Manager of Provider Relations with the maintenance of ACO rosters and ensures daily changes are accurately updated within internal systems e.g. ECHO.
• Supports the Manager, Provider Network Ops to ensure all Boeing plan partner changes are accurately updated in ECHO and various databases.
• Responsible for creating monthly rosters including, but not limited to the following networks: MCIP, MCMG, Boeing, etc.
• Perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.
• Use pertinent data and facts to identify and solve a range of problems within area of expertise.
• Be at work and be on time.
• Follow company policies, procedures and directives.

 
Requirements:

• Minimum of two to four (24) years healthcare experience working in a managed care or information systems setting.
• Familiar with regulatory standards including but not limited to: NCQA, ICE, DMHC, DHCS, CMS, and contracted health plans.
• Interact in a positive and constructive manner.
• Prioritize and multitask.
• Effectively establish and maintain working relationships and proves able to continually follow up with appropriate parties in order to achieve optimal results.
• Track, update, and audit provider information in database.
• Analyze problems by gathering all relevant information and come up with appropriate solutions.
• Pays close attention to detail, accuracy and completeness, and meets deadlines.
• Must understand basic computer logic, conditional statements.
• Must be able to communicate with others clearly, tactfully and professionally.
• Ability to work independently and remain on task.
• Must be detail oriented, good organization and planning skills.
• Ability to prioritize and meet deadlines from multistaff members with the department.
• Must have strong computer skills with a broad knowledge of software packages.  Intermediate level of proficiency with MS Word, Excel and Access.
• Must be able to willingly accept responsibility and possess the desire to learn new tasks.
• Working knowledge of data analysis, data presentation, and preparation of professional documents.
• Preferred Skills & Experience:
• Comparable work experience in areas of Provider Data Management or Provider Network Management.
• Experience with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, DHCS.
• Epic or equivalent Managed Care electronic medical record system and provider portal applications knowledge.
• Required Education:
• Must have a high school diploma.
• Preferred Education:
• Bachelor’s degree in Healthcare Analytics, Health Administration, or related major.
• Languages:    
• English Read   Write   Speak
• Skills: 
• EXCEL

 
Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities