Dignity Health

Provider Data Management Specialist

Job ID
2017-44074
Employment Type
Full Time
Department
Clinical Integration
Hours / Pay Period
80
Facility
Dignity Health Management Services Organization
Shift
Day
REDLANDS
CA
Standard Hours
Mon-Fri (8-5 PM)

Overview

MedProVidex is a wholly-owned subsidiary of Dignity Health and a physician support organization that has historically provided physician practice and IPA management, but has expanded to support the infrastructure for Dignity Health’s Clinical Integration networks.  In this capacity, MedProVidex provides local and corporate support resources to the Southern California Integrated Care Network (SCICN), the St. Rose Quality Care Network (SRQCN), Arizona Care Network (ACN), Sequoia Quality Care Network (SQCN), North State Quality Care Network (NSQCN), and future networks.  MedProVidex is licensed to do business in California, Arizona and Nevada.

Responsibilities

Arizona Care Network (ACN) is a clinically integrated (CI) physician network and Accountable Care Organization (ACO) sponsored by Dignity Health and Abrazo Community Health Network.  The Provider Data Management Specialist is an employee of MedProVidex, a wholly-owned subsidiary of Dignity Health.  Under the direction of the ACN Manager of Provider Network Development, this individual:

 

  • gathers and maintains accurate provider network demographic data,
  • performs periodic provider data reconciliations with multiple data sources, including 3rd party payors,
  • generates reporting on the provider network,
  • conducts network adequacy assessments,
  • develops, maintains and transmits fee schedules as necessary to TPAs and other appropriate stakeholders, and
  • offers support to internal departments/employees on interpretations on provider directory and provider’s network participation status.

 

 
PRINCIPLE DUTIES AND RESPONSIBILITIES

 

  • Responsible for maintaining current, accurate information in all provider database environments by conducting periodic provider data update surveys and processing demographic change requests received from internal and externa sources.
  • Prepares as necessary all provider demographic data in the format required by the CI/ACO Help Desk Team for entry into the Physician Relationship Management Tool SalesForce.com.
  • Runs regular reports on provider data to ensure ongoing accuracy, and reconciles and corrects discrepancies as necessary.
  • Publishes monthly (and otherwise as needed) provider directories for internal and external use.
  • Supports regular communication about demographic and contract status changes (add/delete reports) with internal and external stakeholders, including payors.
  • Communicates with all payors to maintain contract status and effective dates for all providers, and mediates for providers in credentialing/contracting process with payors.
  • Conducts periodic network adequacy assessments.
  • Provides departmental telephone support, serving as the initial point of contact for provider calls directed to ACN.  Conducts necessary research for response or identifies appropriate contact for transfer of calls.
  • Contributes to the preparation of monthly Network Development Committee meeting agendas and application files, including researching various public databases (OIG, BOMEX, etc.).
  • Maintains and updates as necessary the keyword search crosswalk listing for the online provider directory.
  • Acts as internal provider representative sending out information as needed to practices, to include preparing materials (packets, demographic reports, etc.) for use in provider visits.
  • Develops, maintains and transmits fee schedules as necessary to TPAs and other appropriate stakeholders.
  • Performs other duties as assigned.

Qualifications

POSITION QUALIFICATIONS
 

A)           EXPERIENCE:  Minimum 3 years experience in provider relations, provider credentialing, provider database maintenance and reporting, provider contracting and/or network development in a health care or managed care setting required.

B)            EDUCATION AND TRAINING: High school diploma or equivalent required. Bachelors Degree in Business, Finance, Health Care Management, Economics or equivalent preferred.

C)            LICENSE, CERTIFICATION AND REGISTRATION:  None

D)           SPECIALIZED KNOWLEDGE AND SKILLS:  Demonstrated skills in the areas of written and verbal communication, judgment, and problem-solving.  Strong proficiency in Microsoft Office products required.

E)            OTHER REQUIREMENTS:  This position requires a highly motivated person with exceptional customer service, relationship management and interpersonal skills. Attention to detail. Capable of independent thinking, as well as perform in a team environment.

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