Provider Demographic Management Coordinator

Our Client, a Healthcare company, is looking for a Provider Demographic Management 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 with 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.

• Minimum of two to four 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.
• Must be detail oriented, good organization and planning skills.
• Ability to prioritize and meet deadlines from staff members within 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.

• 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.
• Bachelor’s degree in Healthcare Analytics, Health Administration, or related major.

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