Apply on Employer Site

CalOptima · 9 hours ago

Auditor, Provider Data

Orange, CA

Full-time

Hybrid

Entry, Mid Level

$68K/yr - $109K/yr

2+ years exp

CalOptima is a mission-driven community-based organization focused on serving member health with excellence and dignity. The Auditor, Provider Data will conduct ongoing data quality auditing of provider network data, ensuring compliance with regulatory and internal guidelines while providing analytical and administrative support to the Provider Data Operations department.

GovernmentHealth CareNon Profit

Comp. & Benefits

Responsibilities

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 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 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

Provider data managementRegulatory complianceData auditingHealthcare administrationAnalytical skillsMicrosoft OfficeCommunication skillsProblem-solvingProject managementTeam collaboration

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