NEOGOV · 15 hours ago
Auditor, Provider Data
Orange, CA
Full-time
Hybrid
Entry, Mid Level
$68K/yr - $109K/yr
2+ years expCalOptima is a mission-driven community-based organization focused on healthcare excellence. The Auditor, Provider Data will conduct ongoing data quality auditing of the provider network data, ensuring compliance with regulatory and internal guidelines while providing analytical and administrative support within the Provider Data Operations team.
GovTechHuman ResourcesInformation TechnologySoftware
Responsibilities
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 CalOptima Health'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, onboarding and term processes, health network data for network certification and adequacy and the 274 file
Works with vendors and leverages internal and external tools to audit and improve provider data accuracy and integrity
Reviews and breaks down 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 setup within the organization's provider management systems
Analyzes regulatory audit requirements, develops workplans and processes
Conducts data integrity activities to support CalOptima Health's goal of maintaining a high rate of accuracy
Completes other projects and duties as assigned
Qualification
Required
Bachelor's degree in healthcare administration or related field PLUS 2 years of experience working with provider data in a health care or managed care environment required, preferably in a related area of responsibility, such as utilization management, quality management or provider data management; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying
Have access to means of transportation for work away from the primary office approximately 15% of the time required
Preferred
Experience with regulatory compliance and provider data management
Benefits
CalPERS pension program and additional retirement packages.
A generous PTO program
A quality work life balance
Various wellness programs
Tuition Reimbursement
Professional development opportunities
Career development opportunities
Flexible scheduling
Company
NEOGOV
NEOGOV is the leading provider of workforce management software uniquely designed for the public sector, education, and public safety.
501-1000 employees
H1B Sponsorship
NEOGOV has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (11)
2024 (10)
2023 (10)
2022 (18)
2021 (14)
2020 (16)
Funding
Current Stage
Late StageTotal Funding
$700MKey Investors
Warburg Pincus
2025-07-28Secondary Market· $700M
2025-07-28Acquired
2021-06-02Private Equity
Leadership Team
Shane Evangelist
CEO
Brandon McDonald
Head Of Marketing
Recent News
Canada NewsWire
2025-11-14
2025-11-14
Government Technology US
2025-10-31
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