Provider Data Management Coordinator

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 42,000 - 64,000; Full time

Job summary

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

The role reports to the Manager, Provider Data Management & Configuration and includes reconciling contracts and assisting in building an Access-driven provider database for contracted Ancillary, PCPs and Specialists. Other duties include collaborating with Credentialing, Member Services, Quality and Utilization Management on provider

Qualifications

• High school graduate 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, PCPs, 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

English communication

Microsoft Office

Education

High school diploma or equivalent

Tools

Excel

EZ-Cap

Microsoft Office Suite

Job description

Job Description

JOB TITLE: PDM Coordinator FLSA STATUS: Non-Exempt

DEPARTMENT: Provider Data Management & Configuration

REPORTS TO: Manager, Provider Data Management & Configuration

JOB SUMMARY: Responsible for maintaining the provider database system and assist in meeting the overall network growth and development goals.

Essential Job Functions

• 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.

Marginal Job Functions

• Takes on special projects as needed.
• Performs other duties as assigned.

Behavioral Expectations

• Continuous Learning:
• Attends staff meetings as required.
• Attends appropriate training, seminars and workshops as required
• Customer Focus:
• Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

• Fosters appropriate communication and relations with Supervisor, co-workers and other staff.
• Quality/Process Improvement/Safety
• Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.
• Supports and demonstrates safety throughout all duties performed.
• Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

Education/Experience

POSITION REQUIREMENTS:

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

Skills/Knowledge/Ability

• Knowledge of Microsoft Office
• Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to residents and staff.
• Willingness and ability to follow written and verbal direction in English.
• Willingness and ability to maintain appropriate level of confidentiality and privacy.
• Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.
• Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.
• Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
• Ability to effectively prioritize items/tasks as required.
• Willingness and ability to take initiative and be a self-starter.
• Willingness and ability to understand and comply with Federal, State, and local regulations.

Licensure/Certificate/Training

• n/a