Auditor, Provider Data

About the role

We are seeking an Auditor, Provider Data to join our mission-driven team at CalOptima. This role requires a Bachelor's degree in healthcare administration or related field with 2 years of experience in provider data management. The position offers full telework eligibility, with the requirement to work within the State of California approximately 15% of the time.

Responsibilities

• Audit ongoing data quality of CalOptima Health's provider network data, collaborating with internal departments and health networks to remediate data errors.
• Ensure compliance with regulatory and internal guidelines, supporting CalOptima Health's policies and procedures.
• Provide analytical and administrative support to the Provider Data Operations department.
• Audit processes and activities to ensure accuracy and compliance, including provider directories, onboarding and term processes, health network data for network certification and adequacy, and the 274 file.
• Work with vendors and leverage internal and external tools to audit and improve provider data accuracy and integrity.
• Review and breakdown regulatory requirements to identify data impact for audit process updates and implementation.
• Implement and monitor Corrective Action Plans for regulatory and operational compliance.
• Maintain a well-documented audit trail and conduct independent analysis of audit results.
• Maintain ongoing reporting formats for data auditing and analyze regulatory audit requirements.
• Stay updated on provider data requirements and set up within the organization's provider management systems.
• Develop workplans and processes to support data integrity activities.

Qualifications

• Bachelor's degree in healthcare administration or related field.
• 2 years of experience working with provider data in a health care or managed care environment.
• Access to means of transportation for work away from the primary office approximately 15% of the time.

Skills

• Regulatory compliance and provider data management experience.
• Excellent communication and problem-solving skills.
• Ability to work independently and manage multiple projects.
• Strong organizational and analytical skills.
• Proficiency in computer and job-specific applications.

Benefits

CalOptima Health offers a comprehensive benefits package including a CalPERS pension program, tuition reimbursement, professional development opportunities, and more. Competitive compensation is also provided, with a pay grade range of $68,015 - $108,824.

Pay

$32.70 - $52.3192 per hour.

Schedule

The position is approved for full telework, eligible in California only.