Provider Data Quality Auditor II (ALD)

Job description          

Job Category: Administrative, HR, Business Professionals Department: Provider Data Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 4921
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 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 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%)
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.
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 Additional Information
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)
Nearest Major Market: Los Angeles
Job Segment: Audit, Medical, Relationship Manager, Finance, Healthcare, Customer Service
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