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Provider Data Management Specialist

Company: ApolloMed
Location: Pasadena
Posted on: November 19, 2022

Job Description:

SUMMARYThe position will understand the types of provider arrangements and other data elements to be configured in the existing application & other platform applications to support the accuracy & timely payment of claims for the regions' claims system. Make recommendations on system enhancements to improve quality of data and further goals and objectives of the organization. Works with Manager and Supervisor to define code, configure, and maintain detailed provider records. The position clearly understands the products & healthcare services offered to our providers including cost share, limits and regulatory rules and guidelines.ESSENTIAL DUTIES AND RESPONSIBILITIESReviews, analyzes and comprehends appropriate provider data interpretation for setup and maintenance.Loads new provider into EZ-CAP. Verify W-9, NPI, Taxonomy codes and license.Assists in Data collection, analysis, and reporting in coordination with T& C departmentDemonstrates complex problem solving skills by identifying data related issues and suggests solutionsDevelops ability to enter new providers and maintain other production standards established within the unit for data entry and related projects.Assists in maintaining Data Integrity techniques to assure accuracy and consistency of provider information over its entire life-cycle.Assist Coordinators with questions and concernsAssist with provider data clean ups and communicates process improvements to managementDevelops strategies to improve Provider Data processingMaintains provider confidence and protects operations by keeping information confidential at all times.Extracts data and reviews to interpret and identify any required validation activities and to detect issues and/or trends for further analysis. Conducts system audits and provides results for process improvement activities.Manages multiple projects by effectively prioritizing work and communicating workload issues to managementQuickly learns and completes EZ-Cap and non EZ-Cap data entry/other assignments maintaining fast pace environment.Organizes and maintains logs of activities and completed work in designated SharePoint listing.Assist with training new coordinator that joins the team.Assist with auditing the accuracy of provider records loaded in EZ-CAP.Assist with provider data clean ups and communicates process improvements to managementOther duties as assignedQUALIFICATIONSTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Knowledge, experience and understanding of the managed care industry. Knowledge in regulatory guidelines for public and private insurance companies (Medicare/RBRVS, Medi-Cal, etc.). Knowledge of coding classifications including ICD9-CM, CPT4, HCPCs. Strong conceptual, analytical, organizational, and time management skills. Detailed-oriented in both verifying own work as well as the work of others. Proficient understanding of Microsoft Office applications. Over 2 years of Provider Data Management experience necessary.EDUCATION and/or EXPERIENCEHigh school diploma or general education degree (GED); or 3+ years of health care claims processing, credentialing, contracting or utilization management experience and/or training: or equivalent combination of education and experience.#LPIND

Keywords: ApolloMed, Pasadena , Provider Data Management Specialist, Executive , Pasadena, California

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