Provider Demographic Management Coordinator

Position Summary

The Provider Demographic Management Coordinator (PDM Coordinator) is responsible for generating Health Plan notifications including adds, changes and terms. The PDM Coordinator catalogs and tracks all changes and ensures key updates are completed accordingly. In addition, the PDM Coordinator works directly with the Provider Demographic Specialist to ensure the accuracy of network provider information listed on the contracted health plan directories and websites. The PDM Coordinator will assist in maintaining accurate and updated provider matrixes and rosters on internal intranets as well as websites.

Essential Functions and Responsibilities

• Assist the Directory Support Specialist with maintaining departmental matrixes and provider rosters.
• Verify Health Plan directories and websites to ensure accuracy of provider information.
• Responsible for the provider demographic verification and validation of Health Plan rosters.
• Assist other departments with health plan related problems, requests, and questions related to provider information.
• Responsible for assisting with the timely submission of Health Plan Adds, Changes, Terms, and semi-annual and quarterly reports.
• Catalog and track all changes and ensure key updates are completed in accordance with established process flows.
• Generate Health Plan notifications related to Plan Adds, Changes, Terms, etc., and ensure all supporting documents are provided (e.g., W-9s, profiles, original notification requests).
• Support the Manager of Provider Relations with the maintenance of ACO rosters and ensure daily changes are accurately updated within internal systems (e.g., ECHO).
• Support the Manager, Provider Network Operations to ensure all Boeing plan partner changes are accurately updated in ECHO and various databases.
• Responsible for creating monthly rosters including, but not limited to, the following networks: MCIP, MCMG, Boeing, etc.
• Perform any additional or miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge and ability.

Qualifications

• Minimum of 2–4 years of healthcare experience working in a managed care or information systems setting is required.
• Epic or equivalent Managed Care electronic medical record system and provider portal applications knowledge preferred.
• Experience with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, and DHCS preferred.
• Must be able to communicate with others clearly, tactfully, and professionally.
• Ability to work independently and remain on task.
• Must be detail-oriented with strong organization and planning skills.
• Ability to prioritize and meet deadlines from multi-staff members within the department.
• Must have strong computer skills with a broad knowledge of software packages; intermediate level of proficiency with MS Word, Excel, and Access.
• Must be able to willingly accept responsibility and possess the desire to learn new tasks.
• Working knowledge of data analysis, data presentation, and preparation of professional documents required.

Education

• High school diploma required.
• Bachelor's degree in Healthcare Analytics, Health Administration, or related major preferred.
• Comparable work experience in areas of Provider Data Management or Provider Network Management will be considered.