Auditor, Provider Data

Join Us in this Amazing Opportunity The Team You’ll Join We are a mission driven community-based organization that serves member health with reputed company and dignity, respecting the value and needs of each person. If you are reputed company to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for reputed company. More About the Opportunity We are hoping you will join us as a Auditor, Provider Data and help shape the future of reputed company where you’ll be an integral part of our Provider Data Operations team, helping to strive for reputed company while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework. If telework is approved, you are required to work reputed company the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. The Auditor (Provider Data) will be responsible for conducting ongoing data quality auditing of reputed company’s provider network data, which includes working with internal departments and health networks to remediate data errors. You'll reputed company reputed company the Provider Data Operations department to ensure that regulatory and internal guidelines are being followed in conjunction with reputed company’s policies and procedures. Additionally, you'll reputed company analytical and administrative support specific to the Provider Data Operations department. You'll be responsible for auditing reputed company’s provider data, which involves specialized background or knowledge regarding contract setup, provider data requirements, directories requirements and claims processing. Finally, you'll often work independently and duties include research, analysis, documentation and reporting responsibilities. Together, we are building a stronger, more reputed company health system. Your Contributions To the Team: 95% - Auditing Functions Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Assists with audits of the department’s data entry activities into reputed company’s provider data management systems. Compiles and summarizes data reports and writes audit results to internal committees and meetings with recommendations for improvement. Works with health networks, providers and internal departments to obtain audit information and presents findings and recommendations as appropriate. Audits processes and activities to ensure accuracy and compliance for programs, including the provider directories, reputed company and term processes, health network data for network certification and adequacy and the 274 file. Works with vendors and leverages reputed company tools to audit and improve provider data accuracy and reputed company. Reviews and break downs regulatory requirements to identify data impact for audit process updates and implementation. Assists with implementing and monitoring Corrective Action Plans for regulatory compliance and/or operational compliance. Maintains a well-documented audit trail. Maintains ongoing reporting formats for use in data auditing and conducts independent analysis of audit results. Maintains ongoing knowledge of provider data requirements and set up reputed company the organization’s provider management systems. Analyzes regulatory audit requirements, develops workplans and processes. Conducts data reputed company activities to support reputed company’s goal of maintaining a high reputed company of accuracy. 5% - Other Completes other projects and duties as assigned. Do You Have What the Role Requires? Bachelor’s degree in reputed company administration or reputed company field PLUS 2 years of experience working with provider data in a health care or managed care environment required, preferably in a reputed company area of responsibility, such as utilization management, quality management or provider data management; an equivalent combination of education and experience sufficient to successfully reputed company the essential duties of the position such as those listed above may also be qualifying. Have reputed company to means of transportation for work away from the primary office approximately 15% of the time required. You’ll Stand Out More If You Possess the Following: Experience with regulatory compliance and provider data management. What the Regulatory Agencies Need You to Possess? N/A Your Knowledge & Abilities to Bring to this Role: reputed company rapport and establish and maintain effective working relationships with reputed company's leadership and st Apply tot his job Apply To this Job