Provider Enrollment Data Coordinator
Posted on: June 6, 2021
Department(s): Provider Data Management Services
Reports to: Manager, Provider Data Management Services
FLSA status: Non-Exempt
Salary Grade: D - $44,000 - $58,000
The Provider Enrollment Data Coordinator maintains the provider
enrollment database. Functions as a liaison between the health
networks and providers to ensure the accuracy and completeness of
provider data as reflected in CalOptima's databases, systems, and
provider directory. The position will handle identifying,
researching following up, and resolving inconsistent data. This
position collaborates with providers and Network Management and
Provider Relations staff to ensure the provider data received is
accurately recorded and maintained.
- Completes transaction updates in provider system applications
in support of claim adjudication and the provider search tool.
- Performs intake triage and respond to network inquiries.
- Provides on-going department support and research and analysis
essential to resolving concerns/issues raised by providers and
other internal/external customers.
- Review's provider maintenance requests for complete and
- Contact's providers to clarify and resolve data quality
- Identifies data transaction issues that may have contractual
implications or adversely impact service levels.
- Develops rapport with providers and serves as a liaison between
CalOptima provider enrollment, the health networks, and the
- Performs data integrity research and resolves inaccurate
resolving inaccurate or incomplete provider data information.
- Meets monthly production standards.
- Other projects and duties as assigned.
Possesses the Ability To:
- Work independently.
- Establish and maintain effective working relationships with
providers and staff at all levels.
- Prioritize and organize work to meet challenging
- Listen and communicate effectively over the phone and in
- Maintain a professional demeanor in a fast-paced
- Analyze provider data to ensure its integrity.
- Problem-solve provider's and health network's complex
- Enter a high volume of data with minimal errors.
- Type 60 words per minute.
- Communicate clearly and concisely, both verbally and in
- Utilize computer and appropriate software (e.g., Microsoft
Office: Word, Outlook, Excel, PowerPoint) and job specific
applications/systems to produce correspondence, charts,
spreadsheets, and/or other information applicable to the position
Experience & Education:
- High school diploma or equivalent is required.
- 1+ year of experience in general data management or data entry
experience in an automated claims processing, claims research, or
provider maintenance environment required.
- 1+ year of experience working with provider data, provider
relations, provider contracting, health plan operations, or other
health care/medical office environment required.
- Associate degree in Health Care Management preferred.
- Principles and practices of health care service delivery
including Medi-Cal, Medicare, capitation vs. fee-for-service,
commercial plans, provider registration, licensure, and
- Guidelines and regulations specific to the health care
- Appropriate techniques for handling provider inquiries and
- Problem solving, time management and organizational
- Program-specific forms or procedures for assigned program.
CalOptima is an equal employment opportunity employer and makes
all employment decisions on the basis of merit. CalOptima wants to
have qualified employees in every job position. CalOptima prohibits
unlawful discrimination against any employee, or applicant for
employment, based on race, religion/religious creed, color,
national origin, ancestry, mental or physical disability, medical
condition, genetic information, marital status, sex, sex
stereotype, gender, gender identity, gender expression,
transitioning status, age, sexual orientation, immigration status,
military status as a disabled veteran, or veteran of the Vietnam
era, or any other consideration made unlawful by federal, state, or
local laws. CalOptima also prohibits unlawful discrimination based
on the perception that anyone has any of those characteristics or
is associated with a person who has, or is perceived as having, any
of those characteristics.
If you are a qualified individual with a disability or a
disabled veteran, you may request a reasonable accommodation if you
are unable or limited in your ability to access job openings or
apply for a job on this site as a result of your disability. You
can request reasonable accommodations by contacting Human Resources
Disability Management at 657-900-1134.
Keywords: CalOptima, Orange , Provider Enrollment Data Coordinator, Other , Orange, California
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