Provider Data Management Services Coordinator Sr, Covered California

About the role

We are seeking a Provider Data Management Services Coordinator Sr, Covered California to join our team at CalOptima. This position is approved for full telework within the State of California.

Responsibilities

• Build, update, and maintain provider records and data in the CalOptima Health provider system.
• Function as a liaison between health networks and providers to ensure the accuracy and completeness of provider data.
• Identify, research, follow up, and resolve inconsistent data.
• Make and carry out decisions on behalf of the Provider Data Operations (PDO) department within established policies and procedures.
• Process more complex records requiring additional research or problem-solving.
• Lead projects and coordinate work efforts with other project team members.
• Provide on-going department support and guidance for resolving concerns/issues raised by providers and other internal/external customers.
• Contact providers to clarify and resolve complex data quality issues.
• Develop a good rapport and act as a liaison between CalOptima Health's PDO department and health networks and providers.
• Review and assist with updating policies, procedures, and desktop protocols to guide the operation of the PDO department.
• Analyze all system aspects and interpret data from the Facets system to maintain a record of all registered providers for the CalOptima Health Care Network, health networks, Medi-Cal, OneCare, and Covered California lines of business.
• Design training tools and assist in training all new employees and monitor their progress.

Requirements

• A 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.
• 2 years of experience in provider relations, provider contracting, health plan operations, or other health care/medical office environment.

Qualifications

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

Skills

• Develop rapport and establish effective working relationships with CalOptima Health's leadership and 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.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint).
• Organize, be analytical, problem-solve, and possess project management skills.
• Manage a flexible schedule; available to participate in evening and weekend events.
• Manage a fast-paced environment and in an efficient manner.

Benefits

• Competitive compensation.
• CalPERS pension program and additional retirement packages.
• A comprehensive benefits package.
• A generous PTO program.
• Quality work-life balance.
• Variety of wellness programs.
• Tuition reimbursement.
• Professional development opportunities.
• Career development opportunities.
• Flexible scheduling.