Data Operations Support

Description

Location: Bakersfield, CA 93309 (Onsite)
 

Classification: 

Full-Time (Non-Exempt)

Benefits:

· Medical 

· Dental 

· Vision

· Simple IRA Plan

· Employer Paid Life Insurance

· Employee Assistance Program

Compensation:

The initial pay range for this position upon employment commencement is expected to be between $49,982.04 and $62,462.04 annually, translating to $24.03 to $30.03 per hour. However, the base pay offered may be adjusted based on individualized factors, including the candidate's education, certifications, skills, and experience. We value exceptional talent and strive to provide competitive compensation packages tailored to attract and retain top candidates like yourself.

Position Summary:

The Data Operations Support position plays a pivotal role in ensuring the integrity and accuracy

of membership data, supporting the operational efficiency of our organization. This role involves

supporting and reconciling census data, tracking authorizations, and maintaining comprehensive

records to support compliance with health plan requirements. This position is responsible for

generating data-driven reports to identify missed opportunities and provide insights for process

improvements. Additionally, this position supports the creation and distribution of member

communications, manages access to essential systems, and supports various administrative and

special projects.

Job Duties and Responsibilities:

• Reconcile census data between health plans and internal records.

• Supports and update membership data, including Enhanced Care Management (ECM)

membership and various member status lists (e.g., UTR, Disenrollment, Eligibility

Problems).

• Ensure the accuracy of member data entries and resolve discrepancies as needed.

• Track presumptive authorizations and supports the submission process, ensuring all

requests are accurate and supported by appropriate documentation.

• Monitor the authorization appeal process, identifying and reporting discrepancies,

denials, and delays to management.

• Maintains accurate eligibility records/data.

• Assist in processing necessary paperwork and maintain thorough records in the system.

• Utilize Excel to generate reports that identify missed opportunities (e.g., UTR process,

MDT billing) and ensure compliance with health plan requirements.

• Provide data-driven insights to support decision-making and process improvements.

• Coordinate the creation and distribution of various member communications, including

educational materials, UTR letters, disenrollment letters, and marketing materials.

• Maintain accurate records of communications sent and ensure all relevant documents are

uploaded to the appropriate systems.

• Manage incoming faxes by uploading them to the correct member profiles in our Care

Management System and notifying relevant staff.

• Ensure that all documentation is properly stored and accessible for team use.

• Supports access to designated external vendor ECM portals for new hires, including

adding and removing access as directed by ECM management.

• Assist with the Care Management System login setup, creating browser shortcuts, and

adding new staff to email distribution lists and team chats.

• Gather and upload medical records related to the appeal process and Transitions of Care

(TOC) events into member charts.

• Maintain office supplies and frequently used forms in the ECM office.

• Assist in the preparation for community outreach events and handling special projects,

including data testing, validation, and correcting discrepancies.

• Verify member eligibility bi-monthly for both outreach and enrolled members.

• Create and update member profiles in the Care Management Systems.

• Add new members to outreach lists and verify eligibility for those sent via health plans.

• Create outreach files for the outreach team and ensure timely communication of new

attributions.

• Perform all other duties as assigned.

Requirements

• High school diploma or equivalent; a degree or certification in a related field is a plus.

• 2-3 years of experience in data management, healthcare administration, or a related field

preferred.

• Proficiency in the Microsoft Office system is essential.

• Must be detail-oriented with a strong focus on accuracy and data integrity.

• Excellent verbal and written communication skills, with the ability to coordinate with

multiple departments.

• Strong analytical and problem-solving skills, with the ability to identify and resolve data

discrepancies.

• Ability to manage multiple tasks and priorities efficiently.

• Ability to work collaboratively with team members and other departments.