Provider Data Management Coordinator

JOB DESCRIPTION

JOB TITLE: PDM Coordinator FLSA STATUS: Non-Exempt

DEPARTMENT: Provider Data Management & Configuration

REPORTS TO: Manager, Provider Data Management & Configuration

JOB SUMMARY: Responsible for maintaining the provider database system and assist in meeting the overall network growth and development goals.

ESSENTIAL JOB FUNCTIONS:

1. Assist on projects to reconcile no less than 100% of the Specialist/PCP Database with the actual contracts on file identifying discrepancies.

2. Assist in development of an Access driven Provider Database for contracted Ancillary, PCP’s, and Specialists for the generation of various reports.

3. Maintain a daily working relationship with Credentialing, Member Services, Quality and Utilization Management of provider matters, including Credentialing concerns.

4. Maintains a file on all returned contracts that are submitted to Credentialing Department.

5. Assists PDM Supervisor and/or Contracts Representatives on general provider inquiries.

6. Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.

7. Maintains regular and consistent attendance.

8. Adheres to Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS:

1. Takes on special projects as needed.

2. Performs other duties as assigned.

BEHAVIORAL EXPECTATIONS:

1. Continuous Learning:

a. Attends staff meetings as required.

b. Attends appropriate training, seminars and workshops as required

2. Customer Focus:

a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

b. Fosters appropriate communication and relations with Supervisor, co-workers and other staff.

3. Quality/Process Improvement/Safety

a. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.

b. Supports and demonstrates safety throughout all duties performed.

c. Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

· High school graduate or equivalent.

· Excel experience preferred.

· EZ-Cap experience strongly preferred.

SKILLS/KNOWLEDGE/ABILITY:

· Knowledge of Microsoft Office

· Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to residents and staff.

· Willingness and ability to follow written and verbal direction in English.

· Willingness and ability to maintain appropriate level of confidentiality and privacy.

· Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.

· Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.

· Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.

· Ability to effectively prioritize items/tasks as required.

· Willingness and ability to take initiative and be a self-starter.

· Willingness and ability to understand and comply with Federal, State, and local regulations.

LICENSURE/CERTIFICATE/TRAINING:

* n/a