The Provider Demographic Management Coordinator (PDM Coordinator) responsible for generating Health Plan notifications including adds, changes and terms. PDM Coordinator catalogs and tracks all changes and ensures key updates are completed accordingly. In addition the PDM Coordinator will work directly with the Directory Support Specialist to ensure the accuracy of network provider information listed on the contracted health plans directories and websites. The PDM Coordinator will assist in maintaining accurate and updated provider matrixes and rosters on internal intranets as well as websites.
Essential Functions and Responsibilities of the Job
Familiar with regulatory standards including but not limited to: NCQA, ICE, DMHC, DHCS, CMS, and contracted health plans.
Use pertinent data and facts to identify and solve a range of problems within area of expertise.
Work exclusively within a specific knowledge area.
Be at work and be on time
Follow company policies, procedures and directives
Interact in a positive and constructive manner
Prioritize and multitask
Essential Job Outcomes
Assist Directory Support Specialist with maintaining departmental matrixes and provider rosters.
Verify Health Plan directories and websites to ensure accuracy of provider information.
Assists other departments with health plan related problems, requests and questions related to provider information.
Perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability
Responsible for assisting with the timely submission of Health Plan Adds, Changes, Terms, and semi-annual and quarterly reports.
Catalogs and tracks all changes and ensures key updates are completed in accordance to established process flows.
Responsible for generating Health Plan notifications related Plan Adds, Changes, Terms etc. Ensures all the supporting documents are provided (e.g. W-9s, Profiles, original notification request, etc.).
Supports the Manager of Provider Relations with the maintenance of ACO rosters and ensures daily changes are accurately updated within internal systems e.g. ECHO.
Supports the Manager, Provider Network Opsto ensure all Boeing plan partner changes are accurately updated in ECHO and various databases.
Responsible for creating monthly rosters including, but not limited to the following networks: GNP, MCMG, Boeing, etc.
