Title: Provider Demographic Management Specialist

Location: Fountain Valley, CA

Department: IPA - Provider Network

Status: Full-Time

Shift: Days (8hr)

Pay Range*: $29.20/hr - $42.33/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Provider Demographic Management Specialist is responsible for the accuracy of network provider information listed on the contracted health plans directories and websites to ensure the highest level of customer service for our patients during provider enrollment. The Provider Demographic Management Specialist is the primary liaison between the network and its contracted health plans and works with the health plans to resolve issues. It is the responsibility of the Provider Demographic Management Specialist to maintain accurate and updated provider matrixes and rosters on internal intranets and websites as well as handle all requests for rosters by health plans or affiliated partners.

Essential Functions and Responsibilities of the Job

1. Complete assigned tasks in a timely and efficient manner.
2. Track, update, and audit provider information in database.
3. Effectively establish and maintain working relationships, and proves able to continually follow up with appropriate parties to achieve maximum results.
4. Familiar with regulatory standards including but not limited to: NCQA, ICE, DMHC, DHCS, CMS, and contracted health plans.
5. Work and manage multiple projects and prioritize based on importance and urgency
6. Analyze problems by gathering all relevant information and come up with appropriate solutions
7. Pays close attention to detail, accuracy and completeness, and meets deadlines
8. Be at work and be on time
9. Follow company policies, procedures and directive
10. Interact in a positive and constructive manner
11. Prioritize and multitask

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Minimum Requirements

Qualifications/Work Experience:

• A minimum of two (2) years of relevant healthcare experience working in a managed care or information systems setting is required.
• Working knowledge of data analysis, data presentation, and preparation of professional documents required.
• Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is required, experience with Microsoft Access is also preferred.
• Experience with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, HICE, DHCS, preferred.

Education/Licensure/Certification:

• Bachelor’s degree in Healthcare Analytics, Health Administration or related major, Preferred
• Comparable work experience in areas of Provider Data Management or Provider Network Management, Considered