The Directory Support Coordinator (DSC) responsible for generating Health Plan notifications including adds, changes and terms. DSC catalogs and tracks all changes and ensures key updates are completed accordingly. In addition, the DSC will work directly with the Directory Support Specialist to ensure the accuracy of network provider information listed on the contracted health plans directories and websites. The DSC 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
Familiar with regulatory standards including but not limited to: NCQA, ICE, DMHC, DHCS, CMS, and contracted health plans.
Use pertinent data and facts to identify and solve a range of problems within area of expertise.
Work exclusively within a specific knowledge area.
Be at work and be on time
Follow company policies, procedures and directives
Interact in a positive and constructive manner
Prioritize and multitask
Essential Job Outcomes
Assist Directory Support Specialist with maintaining departmental matrixes and provider rosters.
Verify Health Plan directories and websites to ensure accuracy of provider information.
Assists other departments with health plan related problems, requests and questions related to provider information.
Perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability
Responsible for assisting with 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 Plan 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 Relations with the maintenance of ACO rosters and ensures daily changes are accurately updated within internal systems e.g. ECHO.
Supports the Manager of Provider Relations to ensure all Boeing plan partner changes are accurately updated in ECHO and various databases.
Responsible for creating monthly rosters including, but not limited to the following networks: GNP, MCMG, Boeing, etc.
Minimum of 2-4 years healthcare experience working in a managed care or information systems setting is required.
Epic or equivalent Managed Care electronic medical record system and provider portal applications knowledge preferred.
Experience with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred.
Must be able to communicate with others clearly, tactfully and professionally.
Ability to work independently and remain on task.
Must be detail oriented, good organization and planning skills.
Ability to prioritize and meet deadlines from multi-staff members with the department.
Must have strong computer skills with a broad knowledge of software packages. Intermediate level of proficiency with MS Word, Excel and Access
Must be able to willingly accept responsibility and possess the desire to learn new tasks.
Must have a high school diploma. Undergraduate degree preferred
Internal Number: MEM003735
About MemorialCare Medical Foundation
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.