Provider Database Coordinator

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Under supervision, the Provider Database Coordinator ensures the accuracy and completeness of provider data as reflected in Health Net’s databases, systems and provider directory. This position works collaboratively with providers, Network Management and Provider Data Services staff to ensure Health Net provider data is current and accurate. Duties include identifying, researching and resolving inconsistent data.

• Responsible for the accuracy and timeliness of Health Net provider data.
• Enters provider data according to established department standards.
• Reconciles data from various data file types to ensure quality results for internal and external customer bases. Works with provider offices to assure accuracy of provider data.
• Responds to inquiries and issues related to provider data coming directly from providers and other Network Management staff. If necessary, appropriately and timely refer issues to Network Management staff.
• Works with providers and Provider Relations staff to capture and process provider demographic changes. This includes changes received via mail, fax, electronic or from other sources.
• May prepare Inquiry Service Form (ISF) for demographic changes and submits to Provider Data Services for loading in accordance with standard turnaround times.
• Communicates appropriate information/changes to providers to allow to enable timely and accurate claim payment. Conducts ongoing monitoring of provider database including data on facilities and physicians.
• Ensures provider directories are current and accurate.
• Facilitates or assists with special projects and other initiatives to ensure provider data is complete and accurate.
• May participate in training and educational activities for providers and internal customers.

Education/Experience: High School diploma required; some college level coursework desirable.
Three years general data management experience in an automated claims processing, claims research, or provider maintenance environment.
Two years experience in provider relations, provider contracting; health plan operations or health care/medical office environment.

Candidates must be in the Southern California region to be considered for this position. This is a remote position that also requires occasional travel for in-person meetings in the Woodland Hills, CA office.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act