Job Information
L.A. Care Health Plan Provider Network Data Associate II in Los Angeles, California
Provider Network Data Associate II
Job Category: Provider Relations
Department: Provider Data Management
Location:
Los Angeles, CA, US, 90017
Position Type: Full Time
Requisition ID: 11042
Salary Range: $46,800.00 (Min.) - $52,597.00 (Mid.) - $62,270.00 (Max.)
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 Network Data Associate II is in support of the LA Care Health Plan's Medi-Cal, Healthy Families Program, Healthy Kids, Direct Medi-Cal, Special Needs Plan (SNP) and Duals Pilot Product Lines with sole responsibility for monitoring and evaluating the movement of providers across all Plan Partners and Participating Physician Groups (PPG's). Principle duties include maintaining an up to date Provider Database ensuring integrity in order to generate accurate Provider Directories for LA Care Health Plan's various product lines; working in conjunction with Member Services to effectively coordinate member re-assignment upon termination of a Primary Care Provider (PCP); providing assistance to the Claims Department to ensure timely processing of claims payment; and entering new contract into the Manage Health Care (MHC) System and making modifications to existing contracts. The position is responsible for assisting in the collection, analysis and evaluation of data in order to conduct complex studies through the use of statistical tools (e.g. chart, data graphs, and trend analysis) to prepare reports with graphic illustrations that draw conclusions based on findings. Other duties include generating required reports to be submitted to the Department of Managed Care (DMC), Managed Risk Medical Insuarence Board (MRMIB) and Geo Access.
Duties
Provide support to the Provider Relations Department. Support of the L.A. Care Health Plan's Medi-Cal, Healthy Families Program, Healthy Kids, Direct Medi-Cal, SNP and Duals Pilot Product Lines with sole responsibility for monitoring and evaluating the movement of providers across all Plan Partners and Participating Physician Groups (PPG's). Assist in generating/compiling the Provider Network Capacity Report, Quarterly Impact Report to the State and Chief Executive Officer (CEO) Monthly Performance Report for monitoring the physician network. (25%)
Assist Member Services to solve provider discrepancies. Works closely with Member Services to effectively coordinate member re-assignment upon termination of a Primary Care Provider (PCP). (20%)
Coordinate the entry of provider contracts into the MHC and MPD Database. Ensure that provider contracts are properly entered into the MHC an MPD database. Maintaining an up to date Provider Database. Ensure integrity in generating accurate Provider Directories for LA Care Health Plan's various product lines. working in conjunction with Member Services to effectively coordinate member re-assignment upon termination of a Primary Care Provider (PCP). (20%)
Participate in Healthcare Effectiveness Data and Information Set (HEDIS) reporting efforts. (5%)
Ensure that all PPGs receive their Eligibility list within 5 days. (20%)
Perform other duties as assigned. (10%)
Duties Continued
Education Required
High School Diploma/or High School Equivalency Certificate
Education Preferred
Experience
At least to 0-6 year of healthcare work related Care experience, understanding of provider data requirements and claims processing.
Skills
Required:
Access, Excel, Word proficiency.
Strong analytical skills.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
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)