Provider Data Management Analyst

2 weeks ago


Los Angeles, United States Regal Medical Group Full time

This position is directly responsible for researching and maintaining coordination of benefits of all contracted and non-contracted health plan entities as reported by any health plan, provider, Medicare, TPL, Workers Comp or internal departments. They are to ensure that all EZ-Cap system eligibility data is current and accurate. Researches and maintains systems and changes to existing eligibility in a timely manner.


Education and/or Experience:

  • A bachelor’s degree from a four-year college or appropriate industry experience and/or Certification.
  • 3 years experience in Managed Health Care.
  • Previous experience working as a Business Analyst or Project Manager, preferred.
  • Proficient in SQL, Access, and EZ-Cap.
  • Must have knowledge of HMO, PPO, EPO, POS, Government Funded, Medicare and Medicaid plans
  • Must have knowledge of the Department of Managed Healthcare COB guidelines
  • Experience with Windows, Microsoft Office programs, and Outlook.
  • Experience in Customer Service, multi-tasking, and organization.
  • Good verbal and written communication skills.
  • Computer literate with keyboard skills for data entry.


Essential Duties and Responsibilities include the following:

  • When a COB requests are received from internal departments and corporate employee will determine if the health plan and CMS reflect correct COB information.
  • Staff will contact the health plan and verify if the policy is an active employer group policy (large or small) or a retiree policy and obtain a retiree date.
  • Staff will contact the member to confirm their employer group status, active or retired. (Only when the health plan cannot confirm a retiree date, number of employees or any other pertinent information necessary to establish COB according to Medicare guidelines)
  • Staff will notify the employer group to advise them the health plan shows member actively employed, when per the member, they are retired.
  • Review Medicare guidelines to determine if they have obtained all the necessary information from the health plan, employer group, or member to establish correct COB.
  • Contact the CMS COB unit to report that there is or there is no COB if CMS shows Medicare Secondary Payer information.
  • Document in EZ-Cap in the notes field of all activity, calls, CMS MSP status, etc. and respond to appropriate departments of any changes in coordination of benefits.
  • Update COB field in EZ-Cap to reflect correct MSP status according to Medicare guidelines even when CMS & health plan do not yet reflect correct MSP.
  • Follow up with CMS and the health plan in 5 to 10 business days to verify information has been update by both CMS and the health plan. (Continue to follow up with CMS, health plan and member if necessary)
  • Communicates verbally and supplies a summary of COB status at weekly Membership meetings. Is responsible of educating staff and keeping up with changes in Medicare Guidelines.
  • Maintains End Stage Renal Disease Database. Communicates ESRD updates to all appropriate departments.
  • Performs research and analysis of membership
  • Enters new member eligibility records into EZ Cap in accordance with established guidelines.
  • Uses activity analysis reports from the health plans to make changes to existing enrollees; i.e. benefit option changes, terminations, and address changes.
  • Manually audits existing eligibility in EZ Cap against current eligibility.
  • Investigates retroactive cancellations for services rendered by the member after the policy termination date for eligibility guarantee.
  • Researches problem eligibility on authorizations and/or claims forms by calling the health plans or utilizing any other source to resolve the problem.
  • Assists personnel from other departments with eligibility issues.
  • Monitors queue, web site and email for inquiries. Responds timely to membership inquiries.
  • Any other duties as assigned by Lead or Department Head.
  • All other duties as directed by management.



The pay range for this position at commencement of employment is expected to be $30 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.



The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.



Details of participation in these benefit plans will be provided if an employee receives an offer of employment.



If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.



As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.




Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.


Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.



Health and Wellness:

  • Employer-paid comprehensive medical, pharmacy, and dental for employees
  • Vision insurance
  • Zero co-payments for employed physician office visits
  • Flexible Spending Account (FSA)
  • Employer-Paid Life Insurance
  • Employee Assistance Program (EAP)
  • Behavioral Health Services


Savings and Retirement:

  • 401k Retirement Savings Plan
  • Income Protection Insurance


Other Benefits:

  • Vacation Time
  • Company celebrations
  • Employee Assistance Program
  • Employee Referral Bonus
  • Tuition Reimbursement
  • License Renewal CEU Cost Reimbursement Program
  • Business-casual working environment
  • Sick days
  • Paid holidays
  • Mileage


Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.


  • Data Analyst Position

    3 weeks ago


    Los Angeles, California, United States MedPOINT Management Full time

    Job SummaryWe are seeking an experienced Data Analyst to join our team at MedPOINT Management.The successful candidate will be responsible for analyzing and auditing encounter data, as well as creating reports to assist providers and vendors in meeting compliance thresholds.


  • Los Angeles, United States UCLA Health Full time

    Description The Provider Data Management Senior Analyst will be responsible for processing, maintaining, and updating all aspects of the provider information database across all health plan products. You will: Ensure the accuracy and integrity of practitioner information within the company's provider data systems Engage with both internal and external...


  • Los Angeles, United States University of California Full time

    Description The Provider Data Management Senior Analyst will be responsible for processing, maintaining, and updating all aspects of the provider information database across all health plan products. You will: Ensure the accuracy and integrity of practitioner information within the company's provider data systems Engage with both internal and external...


  • Los Angeles, California, United States UCLA Health Full time

    **Job Title:** Provider Data Management Senior Analyst At UCLA Health, we are seeking a highly skilled Provider Data Management Senior Analyst to join our team. As a key member of our organization, you will play a vital role in ensuring the accuracy and integrity of practitioner information within our provider data systems. The ideal candidate will have a...


  • Los Angeles, United States MedPOINT Management Full time

    Job DescriptionJob DescriptionUnder the guidance of the Auditing & Recoveries Manager & Supervisor, the Financial Recovery Data Analyst is responsible for overlooking the OB Maternity Kick agreements for MPM’s Hospital & IPA clients. This includes submitting, tracking & reconciling deliveries. Duties and Responsibilities · Prepare monthly reporting for...

  • Data Analyst Manager

    3 weeks ago


    Los Angeles, California, United States Heluna Health Full time

    Job SummaryWe are seeking a highly skilled Senior Staff Analyst to join our Data Analytics and Reporting team at Heluna Health. As a key member of the team, you will be responsible for managing and directing a team of data analysts, driving forward high-impact projects, and facilitating challenging cross-team coordination efforts.

  • Data Insights Analyst

    3 weeks ago


    Los Angeles, California, United States MedPOINT Management Full time

    Job Title: Data Insights Analyst - Healthcare ReportingAbout the Role:We are seeking a highly skilled Data Insights Analyst to join our team at MedPOINT Management. The successful candidate will be responsible for ensuring accurate, timely, and efficient reporting and data input related to all Claims and UM functions.Key Responsibilities:Data Management:...

  • Data Analyst Developer

    15 hours ago


    Los Angeles, California, United States MedPOINT Management Full time

    Job Overview:The Data Analyst Developer position at MedPOINT Management is responsible for developing, designing, updating, and maintaining reports and dashboards used for analysis by the operational departments. This person prepares reports using various tools depending on which tool is best suited for the project requested.Duties and...


  • Los Angeles, California, United States MedPOINT Management Full time

    Job SummaryWe are seeking a highly skilled Healthcare Financial Data Analyst to join our team at MedPOINT Management. As a key member of our finance department, you will be responsible for leading the preparation and delivery of financial, clinical, and business analysis.


  • Los Angeles, California, United States TalentBurst Full time

    Company Overview:\TalentBurst is a company that offers various solutions for businesses.\\About the Job:\We are looking for an experienced Data Analyst to join our team. As a Data Analyst, you will be responsible for documenting external data acquisition policies and procedures, as well as interfacing with other business units to define and document data...


  • Los Angeles, California, United States MedPOINT Management Full time

    Job OverviewAt MedPOINT Management, we are seeking a highly motivated Business Intelligence Data Analyst to join our team. This role is responsible for ensuring accurate and timely reporting of data related to Claims and UM functions.About the RoleThe ideal candidate will have a strong analytical background, with experience in data analysis, reporting, and...


  • Los Angeles, California, United States MedPOINT Management Full time

    About the RoleAs a Data Insights Analyst - Encounters, you will be responsible for creating and maintaining internal health plan maps, analyzing large data sets, and documenting results. You will also collaborate with other departments, contracted providers, and health plans to enhance data submission quality.The successful candidate will possess excellent...


  • Los Angeles, California, United States The County of Los Angeles Full time

    Job Title: Senior Data Analyst ManagerLocation:Los Angeles, CaliforniaJob Type: Full-timeAbout the Role:We are seeking an experienced Senior Data Analyst Manager to join our team in Los Angeles, California. As a key member of our data analytics department, you will be responsible for overseeing the development and application of advanced statistical methods...

  • Data Analyst

    1 week ago


    Los Angeles, United States Global Techforce Full time

    Global Tech Force is looking for a Data Analyst to join our team. The Data Analyst is responsible for managing our master data set and developing respective reports/visualizations. The ideal person for this position has an exceptional eye for detail, expertise as a data analyst, and a solid understanding of popular data analysis tools. He/she will work...


  • Los Angeles, California, United States UCLA Health Full time

    **Job Summary:** Healthcare Data Analyst ManagerSalary Range: $102,500 - $227,700We are seeking an experienced professional to serve as our Healthcare Data Analyst Manager at UCLA Health. This is a critical role that involves driving the efficient operation of ambulatory clinics through the transformation of raw data into actionable insights.The successful...


  • Los Angeles, California, United States MedPOINT Management Full time

    At MedPOINT Management, we are seeking a highly skilled Financial Recovery Data Analyst to join our team. As a key member of our staff, you will play a critical role in the analysis and reconciliation of medical claims data.This position offers a competitive salary of $65,000 per annum, commensurate with experience.The successful candidate will be...


  • Los Angeles, United States MedPOINT Management Full time

    Job DescriptionJob DescriptionSummaryUnder the general direction of Provider Network Operations (PNO) Project Manager, the Provider Directory Assurance Analyst is responsible for ensuring accurate, timely, and efficient reporting of Client IPA provider network data to the Health Plans, State or Federal entities. This position's primary functions are...


  • Los Angeles, United States PMI (Project Management Institute) Full time

    Channel Data AnalystUnited States * VirtualReq #599Friday, December 27, 2024Are you a dreamer, innovator, thinker, and doer who believes in contributing to something that makes a difference? Pursue your passion. Join PMI.How You'll Make a DifferenceYou will be globally focused on generating insights into ATP (Authorized Training Partner) development through...


  • Los Angeles, California, United States MedPOINT Management Full time

    Job Summary:We are seeking a highly motivated Healthcare Project Manager to join our team at MedPOINT Management. The ideal candidate will have a strong background in project management, analytical skills, and excellent communication abilities.About the Role:Develop and implement projects to improve the provider network and processes.Analyze data to identify...


  • Los Angeles, California, United States MedPOINT Management Full time

    Job SummaryWe are seeking a highly skilled Healthcare Data Analyst to join our team at MedPOINT Management. As a key member of our Provider Network Operations department, you will play a vital role in ensuring the accuracy and efficiency of our reporting processes.About the RoleThe successful candidate will be responsible for managing scheduled and ad-hoc...