Remote Provider Relations Jobs in California (NOW HIRING)

Title: Provider Demographic Management Coordinator

Location: Fountain Valley, Predominantly Remote (Must be located in CA)

Department: IPA Provider Network

Status: Full Time

Shift: Day

Pay Range*: $24.01/hr - $34.81/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups - consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Provider Demographic Management Coordinator (PDM Coordinator) is responsible for generating Health Plan notifications including adds, changes and terms.  PDM Coordinator catalogs and tracks all changes and ensures key updates are completed accordingly. In addition, the PDM Coordinator will work directly with the Provider Demographic Specialist to ensure the accuracy of network provider information listed on the contracted health plans 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 of the Job

• Assist 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.

• Catalogs and tracks all changes and ensures key updates are completed in accordance to established process flows.

• Responsible for generating Health Plan notifications related Plan Adds, Changes, Terms etc. Ensures all the supporting documents are provided (e.g. W-9s, Profiles, original notification request, etc.).

• Supports the Manager of Provider Relations with the maintenance of ACO rosters and ensures daily changes are accurately updated within internal systems e.g. ECHO.

• Supports the Manager, Provider Network Ops 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/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there's more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards

Minimum Requirements

Qualifications/Work Experience:

• Minimum of 2-4 years 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, 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, good organization and planning skills.

• Ability to prioritize and meet deadlines from multi-staff members with 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/Licensure/Certification:

• Must have a high school diploma. 

• 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, considered