Provider Data Coordinator

Sante Health System, Inc.; Fresno (CA); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical, dental, vision, and life ins.

401k retirement plan

Paid time off

Opportunities for advancement

Job summary

Santé Health System is seeking a Provider Data Coordinator to join our Fresno, CA team. In this full-time role, you will coordinate provider demographic data, ensure accuracy, and support regulatory requirements within the Provider Credentialing department.

You will work closely with health plans, providers, and internal staff, maintaining databases, generating reports, and assisting with data validation and roster audits. This position requires attention to detail and teamwork.

Qualifications

• High School diploma/GED equivalent required.
• Three years' experience in data analytics to include at least one year of experience in a healthcare setting preferred.
• Experience and working knowledge of clinic operations.
• Proficient user of MS Office Suite primarily Microsoft Excel.
• Working knowledge of managed care environment and associated lines of business such as HMO/Commercial/Medicare/Medicaid.
• Knowledge of database software applications is a plus.

Responsibilities

• Serves as a key liaison between health plans, providers and internal staff to process, review and communicate provider demographic data.
• Maintains provider database and demographic data for health plan rosters/directories, ensuring that data accurately reflects provider participation on various panels.
• Responsible for communicating demographic changes to health plans and internal staff via template report.
• Generates reports, both routine and ad hoc to appropriate staff or delegated groups.
• Assists health plans with quarterly data validation queries.
• Responds to health plan inquiries related to provider demographic data.
• Accountable for optimal usage of the existing data systems and applications.
• Data mining, summarizing, validation and integrity of provider demographic data.
• Responsible for supporting Provider Credentialing initiatives including data entry, roster audits and overall provider roster.
• Actively participate in health plan meetings, serving as the IPA's representative.
• Actively participate in cross-functional projects having an impact on Provider Credentialing.
• In the spirit of teamwork, employees are expected to follow any other job-related instructions and to perform any other job-related duties as requested.

Skills

MS Excel

Data analytics

Communication

Time management

Teamwork

Problem solving

Education

High School Diploma or GED

Tools

MD Staff platform

Provider data systems

Job description

NOT A REMOTE POSITION

A new opportunity awaits an Provider Data Coordinator at Santé Health System in Fresno, CA. Supporting the Provider Credentialing department, this full-time position is directly responsible for coordinating provider demographic data and ensuring demographic changes are processed timely and accurately along with ensuring accuracy of data as well as meeting all regulatory requirements as applicable.

QUALIFICATIONS

• High School diploma/GED equivalent required.


• Three years' experience in data analytics to include at least one year of experience in a healthcare setting preferred.


• Experience and working knowledge of clinic operations.


• Proficient user of MS Office Suite primarily Microsoft Excel.


• Working knowledge of managed care environment and associated lines of business such as HMO/Commercial/Medicare/Medicaid.


• Knowledge of database software applications is a plus.

CRITICAL SUCCESS FACTORS

Success will require well-developed competencies in these areas:

• Working knowledge of MD Staff platform and related systems and software technologies.


• Ability to exercise initiative, judgment and decision-making.


• Knowledge of local provider market.


• Ability to work independently and as a team member.


• Excellent time management, multi-tasking, and prioritization skills required.


• Ability to effectively communicate with varied professional audiences.


• Ability to assimilate and present information logically.


• Ability to read, analyze and interpret provider demographic data.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Serves as a key liaison between health plans, providers and internal staff to process, review and communicate provider demographic data


2. Maintains provider database and demographic data for health plan rosters/directories, ensuring that data accurately reflects provider participation on various panels.


3. Responsible for communicating demographic changes to health plans and internal staff via template report.


4. Generates reports, both routine and ad hoc to appropriate staff or delegated groups


5. Assists health plans with quarterly data validation queries


6. Responds to health plan inquiries related to provider demographic data


7. Accountable for optimal usage of the existing data systems and applications


8. Data mining, summarizing, validation and integrity of provider demographic data


9. Responsible for supporting Provider Credentialing initiatives including data entry, roster audits and overall provider roster.


10. Actively participate in health plan meetings, serving as the IPA's representative


11. Actively participate in cross-functional projects having an impact on Provider Credentialing


12. In the spirit of teamwork, employees are expected to follow any other job-related instructions and to perform any other job-related duties as requested.

ABOUT SANTE HEALTH SYSTEM

Sante Health System is a Management Services Organization that serves multiple clients. "Sante" is the French word for health. Our name symbolizes our commitment to good health, progressive care, and leadership in our community.

Sante is one of the largest healthcare claims and billing management companies in Central California. The strength of Sante is the extraordinary network of physicians, health plans, and other health service providers it offers the people of our valley. Sante coordinates with physicians, health plans, hospitals, and ancillary providers to ultimately benefit the patient in a managed care environment. Sante Health System provides numerous client services such as billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing/communications, physician services, practice management, provider relations, quality improvement, and utilization management.

Sante is celebrating over 25 years of dedicated service to the community. We deeply understand that we would not be successful in enhancing the quality of life of our patients without our incredible team. This is why we have created a work culture that is comprised of talented, driven, dedicated, innovative, and service-driven professionals. We provide competitive pay, excellent benefits including medical, dental, vision, and life insurance, 401k retirement plan, paid time off, and opportunities for advancement. Being part of our team is like being part of a big family. Join our team and make Sante Health System your home away from home.

www.santehealth.net