Provider Data Management 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

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.

Provider Data Management Full Time Pasadena, CA, US

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.