Provider Data Management Coordinator

Evolving Solution Services; Pasadena (CA); On-site; USD 30,000 - 32,000; Full time

Job summary

Evolving Solution Services in Pasadena, CA is seeking a PDM Coordinator to maintain the provider database system and support network growth within the Provider Data Management & Configuration department.

The role emphasizes data accuracy, contract reconciliation, and collaboration with Credentialing, Member Services, Quality, and Utilization Management to ensure efficient provider data operations and regulatory compliance.

Qualifications

• 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.

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.

Skills

Microsoft Office

Excel

EZ-Cap

Education

High school diploma or equivalent

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Pasadena, CA, US

2 days ago Requisition ID: 1090

Salary Range: $22.00 To $23.00 Hourly

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:

• 1. Assist on projects to reconcile no less than 100% of the Specialist/PCP Database with the actual contracts on file identifying discrepancies.
• 2. Assist in development of an Access driven Provider Database for contracted Ancillary, PCP’s, and Specialists for the generation of various reports.
• 3. Maintain a daily working relationship with Credentialing, Member Services, Quality and Utilization Management of provider matters, including Credentialing concerns.
• 4. Maintains a file on all returned contracts that are submitted to Credentialing Department.
• 5. Assists PDM Supervisor and/or Contracts Representatives on general provider inquiries.
• 6. Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
• 7. Maintains regular and consistent attendance.
• 8. Adheres to Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS:

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

BEHAVIORAL EXPECTATIONS:

• a. Attends staff meetings as required.
• b. Attends appropriate training, seminars and workshops as required

2. Customer Focus:

• a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations and IMAS’s Standards of Conduct.
• b. Fosters appropriate communication and relations with Supervisor, co-workers and other staff.

3. Quality/Process Improvement/Safety

• a. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.
• b. Supports and demonstrates safety throughout all duties performed.
• c. Follows established policies and procedures and understands and complies with all regulators standards set forth by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

• 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.