PROVIDER DATA QUALITY AUDITOR II
2 weeks ago
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 in five health plans, 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.
Job Summary
The Provider Data Quality Auditor II is responsible for the timely and accurate uploading of L.A. Care's provider network data, including identification and remediation of provider data errors. The Provider Data Quality Auditor must foster positive working relationships with both internal and external business partners, including L.A. Care's contracted ndependent Practice Association (IPAs), Medical Groups and Plan Partners. This position must make independent decisions to ensure data quality measures, timelines and organizational policies are met related to provider network data. The position is responsible to conduct ongoing data quality auditing of L.A. Care's provider network data, including working with their assigned provider network accounts to remediate provider data errors.
Duties
Work in a metric driven environment and is expected to understand and work in accordance with all department and company provider data metrics. Work with contracted partners to ensure timely, accurate and successful submissions of all required provider data elements via the Sender Policy Framework (SPF)/Provider Add Change Delete Workflow (PCDW) tasks by continuous provider network data quality oversight and auditing activities. Must work to identify and triage all provider data quality issues. Responsible to ensure that Senate Bill 137 requirements are met, by meeting mandated update periods for the provider's name, practice location or locations, and contact information. Responsible to manage and oversee all Data Fallout reporting as a result of SPF submissions from L.A. Care's contracted entities (IPAs, Medical Groups, Plan Partners, and Vendors). Knowledgeable of reporting formats for use in continuous data auditing, independent analysis of audit results, including root-cause analysis. Must be well-versed in written and verbal communications and is responsible for interacting with contracted partners and provide training and coaching activities to improve overall compliance with the SPF submission. (35%)
Responsible for fostering and maintaining positive working relationships with contracted partners and providing training and coaching activities to improve overall data accuracy. Must work collaboratively with Contracting and Relationship Management Account Managers to ensure that all provider data standards are met in accordance with contracts, regulations, accreditation standards, and L.A. Care Policies and Procedures, including IPA and Medical Group terminations. (15%)
Responsible to follow and execute appropriate procedures when administering provider data system overrides. Responsible to manage provider data quality issues for other L.A. Care business units, including but not limited to, Customer Solutions Center, Provider Services, Contracting and Relationship Management, and Facility Site Review. Responsible for understanding all data related contracts, regulations, accreditation standards, and L.A. Care Policies and Procedures and responsible to assist and train contracted partners about this information on an as needed basis. (20%)
Must have a strong knowledge of Provider Relations and a understanding of how Independent Practice or Physician Association (IPA) and Medical Groups operate. Manage data quality information for other L.A. Care business units, including but not limited to, Customer Solutions Center, Provider Services, Contracting and Relationship Management, and Facility Site Review. (15%)
Manage and oversee all provider data fallout, including reporting of root-cause and resolution. (5%)
Perform other duties as assigned. (10%)
Duties Continued
Education Required
High School Diploma/or High School Equivalency Certificate
Education Preferred
Associate's Degree
Experience
Required:
Minimum of at least 0-2 years of work experience in healthcare or related industry working with data.
Provider Network interaction experience.
Preferred:
Provider Relations, management or sales experience.
Policy and procedure and desktop manual development experience.
Skills
Required:
Excellent communication skills, strong analytical skills, and ability to build strong customer relationships, including the ability to work effectively with diverse team members.
Ability to perform root-cause analyses and recommend effective alternative solutions to handle Provider and Member inquiries, and to provide optimal customer service for internal and external customers.
Ability to multitask in a face-paced work environment and recommend process improvement measures for day to day operations, wherever possible.
Strong PC skills (Word, Excel, Project, etc.)
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional 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
* Medical, Dental and Vision
* Wellness Program
* Paid Sick Leave
Nearest Major Market: Los Angeles
Job Segment: Audit, Relationship Manager, Finance, Customer Service
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