Provider Data & Compliance Coordinator

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 30,000 - 32,000; Full time

Job summary

Imperial Health Plan of California, Inc. in Pasadena, CA is seeking a PDM Coordinator to maintain the provider database system and support network growth.

The role reports to the Manager, Provider Data Management & Configuration and focuses on accurate data management and HIPAA compliance. The candidate should have a high school diploma, Excel experience, and EZ-Cap familiarity, with strong English reading/writing and communication skills for collaboration with Credentialing, Member Services,

Qualifications

• High school diploma or equivalent.
• Excel experience preferred.
• EZ-Cap experience strongly preferred.

Responsibilities

• Assist on projects to reconcile 100% of the Specialist/PCP Database with the actual contracts on file identifying discrepancies.
• Assist in development of an Access driven Provider Database for contracted Ancillary, PCP's, and Specialists for the generation of various reports.
• Maintain a daily working relationship with Credentialing, Member Services, Quality and Utilization Management of provider matters, including Credentialing concerns.
• Maintains a file on all returned contracts that are submitted to Credentialing Department.
• Assists PDM Supervisor and/or Contracts Representatives on general provider inquiries.
• Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
• Maintains regular and consistent attendance.
• Adheres to Compliance Plan and HIPAA regulations.

Skills

Microsoft Office

Excel

Communication skills

Confidentiality

Education

High school graduate

Tools

EZ-Cap

Job description

Imperial Health Plan of California, Inc. in Pasadena, CA is seeking a PDM Coordinator to maintain the provider database system and support network growth.

The role reports to the Manager, Provider Data Management & Configuration and focuses on accurate data management and HIPAA compliance. The candidate should have a high school diploma, Excel experience, and EZ-Cap familiarity, with strong English reading/writing and communication skills for collaboration with Credentialing, Member Services,