Provider Data Management Specialist

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

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