Provider Data Management Services Coordinator Sr

We are a mission-driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. This position has been approved to be Full Telework, requiring work within the State of California only. If Partial Telework is approved, you will also be required to come into the Main Office in Orange, CA, at least two days per week.

About the role

The Provider Data Management Services Coordinator Sr will build, update, and maintain provider records and data in the CalOptima Health provider system. You will function as a liaison between health networks and providers to ensure the accuracy and completeness of provider data in CalOptima Health's databases, systems, and provider directory. Responsibilities include identifying, researching, following up, and resolving inconsistent data, making and carrying out decisions on behalf of the Provider Data Operations (PDO) department, processing complex records, leading projects, and coordinating work efforts with other team members.

Responsibilities

• Participate in a mission-driven culture focused on high-quality performance, customer service, consistency, dignity, and accountability.
• Assist the team in carrying out department responsibilities and collaborate with others to support short- and long-term goals.
• Ensure accuracy and timeliness of CalOptima Health's provider maintenance requests/data to support directory requirements and regulatory reporting.
• Perform accurate and timely baseline demographic transaction updates in provider system applications to support claim adjudication and the provider search tool.
• Lead projects and coordinate work efforts for timely completion.
• Observe intake triage and respond to complex inquiries related to health networks and the provider community.
• Analyze system aspects and interpret data from the Facets system to maintain records of all registered providers for CalOptima Health Care Network, health networks, Medi-Cal, OneCare, and Covered California lines of business.
• Design training tools and assist in training new employees while monitoring their progress.
• Provide ongoing department support and guidance for resolving complex concerns/issues raised by providers and other internal/external customers.
• Contact providers to clarify and resolve complex data quality issues.
• Develop rapport and act as a liaison between CalOptima Health's PDO department and health networks and providers.
• Identify and appropriately escalate data transaction issues that may have significant contractual implications or adversely impact service levels.
• Review and assist with updating policies, procedures, and desktop protocols to guide the operation of the PDO department.
• Complete other projects and duties as assigned (10% of role).

Requirements

• High school diploma or equivalent plus 3 years of general data management experience in automated claims processing, claims research, or provider maintenance environment/managed care organization. An equivalent combination of education and experience may also qualify.
• 2 years of experience in provider relations, provider contracting, health plan operations, or other healthcare/medical office environment.

Preferred Qualifications

• Bachelor’s degree in healthcare administration, business administration, or a related field.
• 2 years of experience with TriZetto's Facets application.

Skills

• Develop rapport and establish effective working relationships with leadership, staff, and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule, including availability for evening and weekend events.
• Organize, analyze, problem-solve, and manage projects effectively.
• Work in a fast-paced environment efficiently.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and other information.

Physical Requirements

• Ability to visually read information from computer screens, forms, and other printed materials.
• Ability to speak clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone and face-to-face interactions.
• Manual dexterity for typing, writing, standing, reaching, flexibility, body movement for bending, crouching, walking, kneeling, and prolonged sitting.
• Lifting and moving objects, patients, and/or equipment weighing 10 to 25 pounds.

Benefits

• Competitive compensation: Pay Grade 305 – $55,966 - $83,949 ($26.91 - $40.36/hour), with final salary based on education, job-related knowledge, experience, skills, and internal equity.
• Comprehensive benefits package.
• CalPERS pension program and additional retirement packages.
• Generous PTO program.
• Work-life balance initiatives.
• Wellness programs.
• Tuition reimbursement.
• Professional and career development opportunities.
• Flexible scheduling.

Schedule

This position is approved for Full Telework (eligible in California only). If Partial Telework is approved, you will be required to work from the Main Office in Orange, CA, at least two days per week.

Work Environment

Work is typically indoors and sedentary, subject to schedule changes and variable work hours, with occasional travel. The noise level is usually moderate. If located at PACE, work may involve a clinical setting serving the frail and elderly, with potential exposure to harmful or hazardous environmental conditions and moderate to loud noise levels. Community-based roles may require occasional outdoor work in varied temperatures and exposure to harmful or hazardous conditions.