Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Provider Enrollment Data Coordinator (19190-092418)

Expired Job

Caloptima Orange , CA 92856

Posted 3 months ago

The Provider Enrollment Data Coordinator maintains the provider enrollment database. Functions as a liaison between the health networks and providers to ensure the accuracy and completeness of provider data as reflected in CalOptima's databases, systems and provider directory. The position will be responsible for identifying, researching following up, and resolving inconsistent data. This position works collaboratively with providers and Network Management and Provider Relations staff to ensure the provider data received is accurately recorded and maintained.

Position Responsibilities:

  • Completes transaction updates in provider system applications in support of claim adjudication and the provider search tool.

  • Performs intake triage and respond to network inquiries.

  • Provides on-going department support and research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.

  • Reviews provider maintenance requests for complete and accurate information.

  • Contacts providers to clarify and resolve data quality issues.

  • Identifies data transaction issues that may have contractual implications or adversely impact service levels.

  • Develops rapport with providers and serves as a liaison between CalOptima provider enrollment, the health networks, and the provider.

  • Performs data integrity research and resolves inaccurate resolving inaccurate or incomplete provider data information.

  • Other projects and duties as assigned.

Required Skills

  • Work independently.

  • Establish and maintain effective working relationships with providers and staff at all levels.

  • Communicate effectively both in writing and verbally.

  • Prioritize and organize work in order to meet challenging deadlines.

  • Listen and communicate effectively over the phone and in person.

  • Maintain a professional demeanor in a fast-paced environment.

  • Analyze provider data to ensure its integrity.

  • Problem-solve provider's and health network's complex issues.

  • Enter a high volume of data with minimal errors.

  • Utilize 10 key and other office software and/or equipment.

  • Type 60 words per minute.

Required Experience

Experience & Education:

  • High school diploma or equivalent is required. Associate's degree preferred.

  • Minimum two (2) years of experience in general data management or data entry experience in an automated claims processing, claims research, or provider maintenance environment required.

  • Minimum one (1) year of experience in provider relations, provider contracting, and health plan operations or other health care/medical office environment required.

Knowledge of:

  • Principles and practices of health care service delivery including Medi-Cal, Medicare, capitation vs. fee-for-service, commercial plans, provider registration, licensure and specialty.

  • Guidelines and regulations specific to the health care field.Problem solving, time management and organizational skills.

  • Appropriate techniques for handling provider inquiries and concerns.

  • Program-specific forms or procedures for assigned program.

Grade: I


Job Location Orange, California, United StatesPosition TypeFull-Time/Regular


See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Medical Transportation Provider / Mobile Care Provider


Posted 1 week ago

VIEW JOBS 12/6/2018 12:00:00 AM 2019-03-06T00:00 <p><strong>Become a Mobile Care Professional with Provado Mobile Health</strong></p><p>Provado Mobile Health is an On-Demand Platform for Community Health and Transportation Services. With our Mobile Health Network of professional and private transportation providers, we service a large community of members of select health plans using your own vehicle.</p><p><br></p><p><strong>Job Description:</strong><br></p><p>We are seeking professional, punctual, polite, and responsible individuals to use their own vehicles to serve as independent Mobile Care Providers, driving members of select health plans to and from their dialysis appointments.</p><p>Often thought of as a healthcare Uber Driver, no medical care is required during transfer – simply reliable, on-time service. Mobile Care Professionals and Driving Caregivers are independent contractors free to work and earn when they want, and as much or as little as they want.</p><p><img src=""></p><p><strong>Requirements</strong></p><p><strong>General Preliminary Requirements:</strong></p><ul> <li>Must be 21 years of age or older</li> <li>Own a clean, mid-size 4 door vehicle (or larger) in good cosmetic and operating condition.</li> <li>Have a clean Criminal Background History free of felonies and violent or sexual crimes (past 7 years)</li> <li>Have a good Driving Record free with no more than one (1) moving violation or accident in the past 3 years, and no license revocations or suspensions in the past 5 years</li> <li>Be currently CPR/First-Aid Certified (or willing to do so)</li> <li>Complete and successfully pass Drug Screening</li> <li>Own an Android or iOS Smartphone (or be willing to obtain one)</li> </ul><p><strong>Network Onboarding Requirements:</strong></p><ul> <li>Complete and pass CTAA’s Passenger Service and Safety (PASS) Basic online training course (2-3 hours; paid for by Provado Mobile Health)</li> <li>Complete and pass NSC’s Driver Safety Course online (2-3 hours; paid for by Provado Mobile Health)</li> </ul><p><strong>Benefits</strong></p><p><strong>Why join our Mobile Health Network?</strong></p><p>Because you are passionate about the freedom to being independent, want higher income for your skills and experience, and the independence of being your own supervisor. In our Mobile Health Network, you have the freedom to work outside the office, and deliver a caring experience to people who need it outside the four walls of a medical facility or home.</p><p>There are part time and full time opportunities available. We have standing-order scheduled trips with regular recurring appointment details, as well on-call positions with full-pay. You can make more income, between $500.00 to $750.00 /weekly + documentation to file for a $.56/mile tax credit. Per year, Mobile Care Professionals earn can $35,000, plus have documentation for mileage tax credit of over $1,000/month (enough to cover the entire cost of owning and operating a new car).</p> Provado Orange CA

Provider Enrollment Data Coordinator (19190-092418)

Expired Job