Provider Data Coordinator
Company: Gold Coast Health Plan
Location: Camarillo
Posted on: August 5, 2022
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Job Description:
Job DescriptionPOSITION SUMMARYThis position is responsible for
performing all activities related to provider data base management
for the Provider Relations Department. The individual is a key
department asset in performing provider database management, which
includes the maintenance integrity, security and processing of data
and files in an information system and data processing environment.
Further, the position is responsible for ensuring the accuracy and
timeliness of data entry of provider network data into the Provider
Relations department software. Assist with all provider data
management including contracted and non-contracted provider data
and other software programs by GCHP. This position is also
responsible for following all department and company policies;
proactively and reactively seeking appropriate solutions to
existing issues; fully accountable for maintaining positive working
relationships with internal and external stakeholders and
clients.ESSENTIAL FUNCTIONSReasonable Accommodations StatementTo
accomplish this job successfully, an individual must be able to
perform, with or without reasonable accommodation, each essential
function satisfactorily. Reasonable accommodations may be made to
help enable qualified individuals with disabilities to perform the
essential functions. Essential Functions Statement(s)• Lead
face-to-face educational visits with physicians and their office
staff to educate them on other Gold Coast Health Plan policy and
procedures. • Ability to answer many claims submission questions
and have a good understanding of physician claims processing. •
Receives, researches, processes provider/location requests related
to additions, changes, terminations, and ensures all requests are
logged in appropriate database for performance measurement.•
Evaluates researches and resolves complex provider data maintenance
requests and issues.• Understands the credentialing process and
provider impacts of the credentialing process• Act as a liaison
between Gold Coast Health Plan and the provider community to
effectively resolve provider issues, address concerns and resolve
problems. • Reach out telephonically to physicians and their staffs
to follow up on information needed by Gold Coast Health Plan. • Be
familiar with Gold Coast Health Plan's contract requirements for
PCPs and Specialists. • Coordinate and conduct regularly scheduled
meetings with providers and follow-up on outstanding issues. • Work
with providers to adhere to contract and regulatory requirements. •
Identifies opportunities to improve processes to ensure efficient
turnaround of issues and meets and exceeds established deadlines
and performance standards.• Identifies trends related to data
structure/set up and reports trends with proposed solutions to
management. • Respond to provider requests, inquiries, and needs in
a timely manner. • Initiate face-to-face visits with the provider
and office staff at the provider's location in order to respond to
the individual provider needs. • Research and resolve claims and
authorization issues and/or elevate to other Plan management.•
sures provider directories are current and accurate.• Develop and
deliver presentations on various business topics to the provider
community. • Facilitates or assists with special projects and other
initiatives to ensure provider data is complete and accurate.•
Other duties as assigned by management. POSITION
QUALIFICATIONSCompetency Statement(s) • Management Skills - Ability
to organize and direct oneself and effectively supervise others. •
Initiative - Ability to make decisions or take actions to solve a
problem or reach a goal. • Customer Oriented - Ability to take care
of the customers' needs while following company procedures. •
Diversity Oriented - Ability to work effectively with people
regardless of their age, gender, race, ethnicity, religion, or job
type. • Interpersonal - Ability to get along well with a variety of
personalities and individuals. • Time Management - Ability to
utilize the available time to organize and complete work within
given deadlines. SKILLS & ABILITIESEducation: Bachelor's Degree
(four year college or technical school), Field of Study: Business
Administration, Health Care Administration or other related field
preferred Experience: 4 plus years of experience in the health care
field interacting directly with providers. Direct experience with
physician offices and be familiar with physician claims related
issues. Computer Skills: Advanced computer skills included in the
MS Office products. Certifications & Licenses: A valid California
Driver's License and insurance. Other Requirements: Act as a
liaison between the provider and Gold Coast Health Plan. Must be
able to work the internal and external systems in order to achieve
the desired result.Be familiar with claims related issues and be
able to help resolve them.Be familiar with and able to interpret
policy and procedures and various contracts.Respond appropriately
to provider inquires in order to alleviate confusion or
frustration.Become familiar with IKA internal business
systems.Participate in audits and readiness assessments to assess
contract compliance.Prioritize tasks in order to meet challenging
deadlines.
Keywords: Gold Coast Health Plan, Camarillo , Provider Data Coordinator, Other , Camarillo, California
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