Provider Data Management Coordinator

AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!

Does the idea of doing something that really makes a difference in peoples lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?

If so, AIDS Healthcare Foundation is the place for you!

Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.

AHFs core values are:

  • Patient-Centered

  • Value Employees

  • Respect for Diversity

  • Nimble

  • Fight for Whats Right

Benefits at AHF

AHF offers comprehensive benefits to help our employees do and be their very best! These benefits are intended to enhance employee physical, financial, spiritual and professional health.

Support efforts of Provider Relations, Claims and Credentialing departments in ensuring accurate and complete provider demographics, including all information needed for the acceptance of encounters, provider network files, and enrollment files by CMS and DMHC.

Responsible for entering initial credentialing, demographic and contract information in HealthSuite claims processing system for newly contracted providers, delegated provider groups and non-contracted providers.

Responsible for accuracy and completeness of provider information in HealthSuite claims processing system by tracking terminations and additions to provider network and remediating or completing any information needed not included on files supplied by various PHP/PHC network affiliates.

Responsible for maintaining provider contracts, W-9 information and fee schedules in Claims Processing system for correct claim adjudication processes, and analyzing exception reports when provider information included on submitted files and information present in system conflicts.

Responsible for working with Provider Relations and IT Departments on submission compliance of required regulatory and other regularly scheduled network reports, including provider terminations and additions, and provider directories. Performing claims processing system reconfiguration, assist in Kiriworks implementation and manage vendor contracts library.

Assist in CMS Audit preparations and responses, Finance and Accounting depts in financial audits and reconciliations, communicating with participating providers on recoupments, verification of providers W-9 forms to maintain compliance for 1099s distribution and etc.

Responsible for auditing the Provider Directories on a quarterly basis. Responsible for maintaining current provider files, including incoming/outgoing correspondence.

Collaborates with other Managed Care teams to assure provider information is up to date and accurate, (correct addresses, TIN#, NPI, network/provider affiliations, addition/deletion of providers from practices, etc.)

Responsible analyzing exception reports for missing provider information and fee schedules to resolve claim adjudication conflicts in Claim Processing system.

Works closely with Provider Relations and Claims departments to make sure Claims Processing system contains the most accurate and complete provider demographics needed for the acceptance of encounters, provider network files, and enrollment files. Asist Claims Dept in reviewing suspended or denied claims for efficient and timely provider reimbursements to avoid sanctions by CMS and DHCS agencies

Works closely with Credentialing department tracking terminations and additions to provider network and remediating or completing any information needed not included on files supplied by various network affiliates.

The PDM Coordinator will be required to manage multiple projects while meeting deadlines, making sure accurate data is delivered in a timely fashion, which is essential to the companys progress and growth.

We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment. AHF will consider qualified applicants with criminal histories in a manner consistent with the requirements of the ordinance.

Req No: 2023-16762

External Company URL: www.aidshealth.org

Street: 6255 Sunset Blvd Fl 19

by Jobble

Related Post

Underwriter, CyberUnderwriter, Cyber

Underwriter, Cyber/Tech E&OCompany DescriptionAllied World Assurance Company Holdings, Ltd, through its subsidiaries, is a global provider of insurance and reinsurance solutions. We operate under the brand Allied World and have