Provider Data Quality Auditor II (ALD)

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 55,000 - 83,000; Full time

Job summary

L.A. Care Health Plan seeks a Provider Data Quality Auditor II to ensure accurate provider network data management. The role involves fostering relationships, conducting audits, and ensuring compliance with data quality standards. This full-time position offers a competitive salary and benefits, supporting the mission to provide quality healthcare for vulnerable communities.

Benefits

PTO

Tuition Reimbursement

Retirement Plans

Medical/Dental/Vision Coverage

Wellness Programs

Qualifications

• Minimum of 2 years in healthcare or a related industry.
• At least 2 years working with data.

Responsibilities

• Ensure all provider data metrics are met and triage data quality issues.
• Maintain relationships with contracted partners and provide training.
• Manage data quality information for multiple units.

Skills

Communication

Analytical Skills

Root-Cause Analysis

Process Improvement

Education

Associate's Degree

Job description

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Provider Data Quality Auditor II (ALD)

Job Category: Provider Relations

Department: Provider Data Management

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 12223

Salary Range: $55,245.00 (Min.) - $69,045.00 (Mid.) - $82,867.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members. Our mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents, supporting the safety net required to achieve that purpose.

The Provider Data Quality Auditor II is responsible for the timely and accurate uploading of provider network data, including identification and remediation of data errors. The role involves fostering positive relationships with internal and external partners, making independent decisions to meet data quality standards, and conducting ongoing data audits to ensure accuracy.

Duties

1. Work in a metric-driven environment to ensure all provider data metrics are met, including timely submissions via SPF/PCDW workflows. Identify and triage data quality issues, ensuring compliance with Senate Bill 137 update periods. Manage Data Fallout reporting and perform root-cause analysis. Provide training and coaching to contracted partners to improve compliance. (35%)
2. Maintain positive relationships with contracted partners, providing training and coaching to enhance data accuracy. Collaborate with Contracting and Relationship Management to ensure provider data standards are met, including handling terminations. (15%)
3. Follow procedures for provider data system overrides, manage data quality issues across various L.A. Care units, and understand all related contracts, regulations, and policies. Provide training to contracted partners as needed. (20%)
4. Possess strong knowledge of Provider Relations and the operations of IPAs and Medical Groups. Manage data quality information for multiple units. (15%)
5. Oversee all provider data fallout, including root-cause reporting and resolution. (5%)
6. Perform other duties as assigned. (10%)

Education Required

Associate's Degree

Experience

Required: Minimum of 2 years in healthcare or a related industry, with at least 2 years working with data.

Preferred: Provider Relations, management or sales experience; policy and procedure development experience.

Skills

Required: Excellent communication, analytical skills, and ability to build strong relationships. Capable of root-cause analysis and recommending solutions. Able to multitask and suggest process improvements.

Licenses/Certifications

Required and Preferred sections are empty or not specified.

Training

Not specified.

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The pay range depends on various factors and is subject to change.

This is a limited-duration position, lasting from one to two years, with full benefits. L.A. Care offers benefits including PTO, tuition reimbursement, retirement plans, medical/dental/vision coverage, and wellness programs.