Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
Manage operational and administrative functions to support the accuracy, integrity, and timely processing of provider data.
DUTIES & RESPONSIBILITIES:
- Develop, generate, and monitor reports to support the accuracy and integrity of the provider data. Conduct routine audits. Provide trend reports, potential network gaps, or other areas of concern to management.
- Assist in the resolution or escalation of questions and issues received from internal staff, providers, or physician groups.
- Intake and coordinate data requests from other departments and generate reports for management and external providers or physician groups.
- Manage, distribute, and monitor workload and timely processing of incoming provider data requests (additions, changes, and terminations).
- Manage process for new IPAs or Medical Group to register providers in the plan’s database and meet network adequacy and other regulatory requirements.
- Provide on-going maintenance of the provider files, physician group contact listings, key provider contacts, and other information pertinent to the accuracy and integrity of provider data.
- Maintain accurate and current provider database by conducting internal audits and error corrections of the database.
- Establish desk top procedures, develop training materials, and train staff.
- Maintain current knowledge of regulatory guidelines and requirements and all internal business rules pertaining to applicable lines of business. Maintains current knowledge of the applicable database system used by plan (currently CACTUS).
- Maintain the security of the Provider files, databases, and other confidential data.
- Experience validating and processing provider data (additions, changes, and terminations) in a health plan, MSO, or physician group (IPA) setting
- Experience in managing special projects or implementing a new process
- Minimum of High School diploma or equivalent
- Proficient with computer applications to include but not limited to Excel, Word, Outlook, CACTUS (preferred), and EZ-CAP (Preferred)
- Must be able to lift a minimum of 25 pounds
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.