Provider Data Management & Compliance Coordinator

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Imperial Health Plan of California, Inc. is seeking a PDM Coordinator to maintain the provider database and support network growth. The role interfaces with Credentialing, Member Services, Quality and Utilization Management to resolve provider-related issues while ensuring privacy controls are followed.

The position requires attention to detail, strong organizational skills, and the ability to work across departments on data projects, while adhering to HIPAA and compliance standards.

Qualifications

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

Responsibilities

• Assist on projects to reconcile no less than 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.
• Takes on special projects as needed.
• Performs other duties as assigned.

Skills

Microsoft Office

English communication

Confidentiality

Multitasking

Teamwork

Attention to detail

Problem solving

Time management

Reading/writing English

Education

High school diploma or equivalent

Tools

Microsoft Access

Excel

EZ-Cap

Job description

Imperial Health Plan of California, Inc. is seeking a PDM Coordinator to maintain the provider database and support network growth. The role interfaces with Credentialing, Member Services, Quality and Utilization Management to resolve provider-related issues while ensuring privacy controls are followed.

The position requires attention to detail, strong organizational skills, and the ability to work across departments on data projects, while adhering to HIPAA and compliance standards.