PDM Coordinator (Provider Demographic Management)

Position Summary

The Provider Demographic Management (PDM ) Coordinator is 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 PDM 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

• Complete assigned tasks in a timely and efficient manner.
• Effectively establish and maintain working relationships, and proves able to continually follow up with appropriate parties in order to achieve optimal results
• Familiar with regulatory standards including but not limited to: NCQA, ICE, DMHC, DHCS, CMS, and contracted health plans.
• Track, update, and audit provider information in database
• Work and manage multiple projects and prioritize based on importance and urgency
• Analyze problems by gathering all relevant information and come up with appropriate solutions
• Pays close attention to detail, accuracy and completeness, and meets deadlines
• Must understand basic computer logic, conditional statements
• Be at work and be on time
• Follow company policies, procedures and directive
• Interact in a positive and constructive manner
• Prioritize and multitask, while maintaining data integrity
• Verify Health Plan directories and websites to ensure accuracy of provider information.
• Assist PDM Specialist with maintaining departmental matrixes and provider rosters.
• Assists other departments with health plan related issues, requests and questions related to provider information.
• Responsible for 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 provider 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 Network Operations with the maintenance of ACO rosters and ensures daily changes are accurately updated within internal systems, e.g. ECHO.
• Responsible for creating monthly rosters including, but not limited to the following networks: GNP, MCMG, Boeing, Worker's Compensation, etc.
• Responsible for the provider demographic verification and validation of Health Plan rosters
• Other duties as assigned.

Qualifications/Work Experience:

• A minimum of two (2) years of relevant healthcare experience working in a managed care or information systems setting is required.
• Working knowledge of data analysis, data presentation, and preparation of professional documents required
• Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is required, experience with Microsoft Access is also preferred.
• Experience with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred.

Education/Licensure/Certification:

• Must have a high school diploma
• Bachelor's degree in Healthcare Analytics, Health Administration or related major, Preferred
• Comparable work experience in areas of Provider Data Management or Provider Network Management, Considered