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