Provider Network Data Associate II
2 months ago
Salary Range: $46, Min.) - $52, Mid.) - $62, Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Provider Network Data Associate II is in support of the L.A. Care Health Plan's Medi-Cal, Healthy Families Program, Healthy Kids, Direct Medi-Cal, Special Needs Plan (SNP) and Duals Pilot Product Lines with sole responsibility for monitoring and evaluating the movement of providers across all Plan Partners and Participating Physician Groups (PPG's). Principle duties include maintaining an up to date Provider Database ensuring integrity in order to generate accurate Provider Directories for L.A. Care Health Plan's various product lines; working in conjunction with Member Services to effectively coordinate member re-assignment upon termination of a Primary Care Provider (PCP); providing assistance to the Claims Department to ensure timely processing of claims payment; and entering new contract into the Manage Health Care (MHC) System and making modifications to existing contracts. The position is responsible for assisting in the collection, analysis and evaluation of data in order to conduct complex studies through the use of statistical tools (e.g. chart, data graphs, and trend analysis) to prepare reports with graphic illustrations that draw conclusions based on findings. Other duties include generating required reports to be submitted to the Department of Managed Care (DMC), Managed Risk Medical Insurance Board (MRMIB) and Geo Access.
DutiesProvide support to the Provider Relations Department. Support of the L.A. Care Health Plan's Medi-Cal, Healthy Families Program, Healthy Kids, Direct Medi-Cal, SNP and Duals Pilot Product Lines with sole responsibility for monitoring and evaluating the movement of providers across all Plan Partners and Participating Physician Groups (PPG's). Assist in generating/compiling the Provider Network Capacity Report, Quarterly Impact Report to the State and Chief Executive Officer (CEO) Monthly Performance Report for monitoring the physician network. (25%)
Assist Member Services to solve provider discrepancies. Work closely with Member Services to effectively coordinate member re-assignment upon termination of a Primary Care Provider (PCP). (20%)
Coordinate the entry of provider contracts into the MHC and MPD Database. Ensure provider contracts are properly entered into the MHC an MPD database. Maintain an up to date Provider Database. Ensure integrity in generating accurate Provider Directories for LA Care Health Plan's various product lines working in conjunction with Member Services to effectively coordinate member re-assignment upon termination of a Primary Care Provider (PCP). (20%)
Participate in Healthcare Effectiveness Data and Information Set (HEDIS) reporting efforts. (5%)
Ensure all PPGs receive their Eligibility list within 5 days. (20%)
Perform other duties as assigned. (10%)
Duties ContinuedEducation Required
High School Diploma/or High School Equivalency CertificateEducation Preferred
Experience
Required:
At least 6 months of healthcare work related Care experience, understanding of provider data requirements and claims processing.
SkillsRequired:
Access, Excel, Word proficiency.
Strong analytical skills.
Licenses/Certifications RequiredLicenses/Certifications Preferred
Required Training
Physical Requirements
LightAdditional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
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