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Provider Enrollment Data Coordinator

Company: CalOptima
Location: Orange
Posted on: June 6, 2021

Job Description:

Department(s): Provider Data Management Services

Reports to: Manager, Provider Data Management Services

FLSA status: Non-Exempt

Salary Grade: D - $44,000 - $58,000

Job Summary

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.

Position Responsibilities:

  • 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 accurate information.
  • Contact's providers to clarify and resolve data quality issues.
  • 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 provider.
  • 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 deadlines.
  • Listen and communicate effectively over the phone and in person.
  • Maintain a professional demeanor in a fast-paced environment.
  • Analyze provider data to ensure its integrity.
  • Problem-solve provider's and health network's complex issues.
  • Enter a high volume of data with minimal errors.
  • Type 60 words per minute.
  • Communicate clearly and concisely, both verbally and in writing.
  • 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 assignment.

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.

Preferred Qualifications:

  • Associate degree in Health Care Management preferred.

Knowledge of:

  • Principles and practices of health care service delivery including Medi-Cal, Medicare, capitation vs. fee-for-service, commercial plans, provider registration, licensure, and specialty.
  • Guidelines and regulations specific to the health care field.
  • Appropriate techniques for handling provider inquiries and concerns.
  • Problem solving, time management and organizational skills.
  • 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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