Delegation Oversight & Provider Data Auditor

Job Details Location: Corporate Headquarters - Chula Vista, CA 91914 Position Type: Full Time Salary Range: $29.11 - $32.03 Hourly Position Summary Provides advanced analytical techniques to ensure accurate contract information is applied for data entry into Symplr with correlation to QNXT system. Ensures company maintains high standards and compliance to regulatory requirements by maintaining effective multi-departmental improvement database which integrates and coordinates results of all assessment/evaluation activities, problem identification and resolution activities. Responsible for accurate written and electronic provider directories. Responsible for the Oversight and Auditing activities as it pertains to our Delegates. Responsible for generating, maintaining and monitoring the departments Daily Audits that capture the data entry in the Symplr credentialing database. Compliance with Regulations Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including DHCS, DMHC, CMS and/or Medicare Part D and Special Needs Plan (SNP). Responsibilities Develop operations procedures by coordinating the gathering of provider information internally through contract development and claims submission, and externally through survey or by direct contact with network providers. Determine contracts to be assigned to providers by reviewing contract language. Maintain, produce and distribute network provider directories for all plan types by updating and maintaining provider site listings, creating database queries to produce accurate primary care site listings and hospital, specialty and ancillary referral panels. Inform all affected departments of updated information by meetings with or by routing notices through inter-company mail and e‑mail to appropriate staff in Operations Claims, Health Care Services, Financial Services and Information Systems Divisions. Understand credentialing information (license types, provider types, & scope of practice) so data entry of QNXT will match provider’s credentials and scope of practice. Provide information as requested and contribute to the team effort by producing reports, labels and directories in a timely manner; maintain established departmental policies and procedures, objectives, safety and environmental control standards; enhance professional growth and development through participation in educational programs, current literature, in-service meetings and workshops; attend meetings as required and participate on committees as directed; work closely with Operations Claims and Information Systems; and perform other related duties as assigned or requested. Maintain product and company reputation and contribute to the team effort by conveying professional image and accomplishing related tasks. Maintain the Oversight and Auditing activities as it pertains to our Delegates. Generate, maintain and monitor the departments Daily Audits that capture the data entered in the Symplr credentialing database. Qualifications Education Associate of Arts Degree or equivalent work experience Experience/Skills 2 years work experience or minimum education. Ability to operate a personal computer, fax and copier. Knowledge of Vistar and QNXT database. Proficient in word processing and database management applications. Strong problem solving and analytical skills. Thorough, accurate and detail oriented. Ability to establish and maintain rapport with staff at all levels in problem resolution and development of reports and procedures. Physical Requirements May be required to work evenings and/or weekends. The above statements describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All qualified applicants will receive consideration for employment based on merit, without regard to race, color, religion, sex, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law. #J-18808-Ljbffr