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Provider Data Management Specialist

1 month ago

Redlands, United States Dignity Health Full time

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

Responsibilities

***This position is remote, with a preference for the candidate to reside in the Inland Empire (Riverside, San Bernardino, Ontario, CA) region.

Position Summary:

The Clinical Integration (CI) and Accountable Care Organization (ACO) programs are clinically integrated physician networks sponsored by Dignity Health (DH). Similar to the CI/ACO Networks, the Greater Sacramento Service Area (GSSA) Network is a partnership between Mercy Medical Group, Woodland Clini,c and Hill Physicians Medical Group. In addition, in order to fill service gaps in a CI/ACO Network, a complementary network of ancillary providers is maintained in each region.

The Provider Data Management Specialist is an employee of Dignity Health Management Service Organization. Under the direction of the CI/ACO Manager this individual:

  • provides data management support services to Dignity Health’s CI/ACO Networks Employer Relations and Valued Based Operations (VBO)

  • within the Salesforce platform, this individual gathers and maintains accurate provider data, performs periodic provider data reconciliations with multiple data sources including 3rd party payors

  • generates reporting on the provider network

  • conducts review of network adequacy and capabilities

  • maintains and transmits fee schedules, as necessar,y to third-party administrators (TPA's) and other appropriate stakeholders

  • provides customer support services to Dignity Health CI/ACO Networks and VBO’s team.

Qualifications

Minimum Qualifications:

  • 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

  • High school diploma or equivalent required

  • Demonstrated skills in the areas of written and verbal communication judgment and problem-solving

  • Strong proficiency in Microsoft Office products required

  • This position requires a highly motivated person with exceptional customer service, relationship management and interpersonal skills

  • Attention to detail

  • Capable of independent thinking

  • Ability to perform in a team environment

Preferred Qualifications:

  • Bachelor’s Degree in Business, Financ,e Health Care Management, Economics or equivalent preferred.

Pay Range

$23.00 - $31.38 /hour

We are an equal opportunity/affirmative action employer.