Provider Data Coordinator

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work - Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP's focuses on 5 Core Values in the workplace:

* Integrity

* Accountability

* Collaboration

* Trust

* Respect

Disclaimers:

* Flexible work schedule is based on job duties, department, organization, or business need.

* Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Provider Data Coordinator serves as a strategic steward of provider information, ensuring its integrity, accessibility, and compliance across all systems. This role owns the end-to-end management of roster files and provider directories-print and digital-while proactively updating contracted and non-contracted provider records to reflect accurate data in real time. With a sharp eye for discrepancies, the Coordinator resolves issues swiftly to support operational readiness and regulatory alignment. They collaborate cross-functionally with internal departments, external providers, and third-party vendors to streamline data workflows and maintain high service standards. The position also contributes to executive reporting and external regulatory submissions, supporting audit preparedness and organizational compliance initiatives.

Amount of Travel Required: 10-15%

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

* Oversee provider roster data, including new entries, terminations, updates, and discrepancies.

* Partner with external vendors to ensure accuracy and completeness of provider records.

* Maintain organized documentation of all roster changes and updates for audit and compliance purposes.

* Track provider submissions to verify timely updates and roster adherence.

* Resolve data issues impacting claims processing, coordinating with providers and internal teams.

* Provide training and user support for sPayer, GCHP's provider data management platform.

* Configure system dropdowns, validate entries, and assist with User Acceptance Test (UAT) scripting for enhancements.

* Work closely with IT, business analysts, and operations to define data formatting requirements and optimize provider data workflows.

* Propose improvements to roster tracking systems and file extract processes.

* Lead and coordinate meetings with provider offices to review data submission protocols and close outstanding items.

* Communicate expectations and follow-up actions clearly and professionally.

* Develop dashboards and reporting tools using Excel to support internal data monitoring and vendor communication.

* Generate visual insights through pivot tables, filters, and charts.

* Act as a key point of contact for provider inquiries and changes (e.g., location updates, demographics).

* Investigate complex discrepancies and collaborate across departments to resolve data conflicts.

* Lead alignment of provider rosters and directory data aligns with Medicare, Medi-Cal, DHCS, CMS, and NCQA requirements.

* Format directories using Adobe Acrobat and internal web-based requirements to meet content and structure standards.

* Write clear, concise emails, memos, and documentation for internal and external stakeholders.

* Lead and support projects that enhance data quality, operational efficiency, and provider engagement.

* Perform additional tasks as assigned by management in support of departmental goals.

MINIMUM QUALIFICATIONS

Required Education and Experience:

* 5 plus years of experience in the health care field interacting directly with providers, provider network operations, or a similar healthcare-related role.

* 3 years' experience with physician offices and knowledge of physician roster related issues.

* Proficiency in systems like Provider Contracting & Credentialing Management System (PCCM) or similar provider management tools.

* Demonstrated ability to manage and audit data.

* 3 years of provider data management experience.

* 2 years Project Management: Strong organizational skills with a proven track record of managing and executing projects effectively

KNOWLEDGE, SKILLS & ABILITIES

Preferred Education and Experience:

* Bachelor's Degree

* 2-year experience with rosters and provider directories coordination and management

* Experience and knowledge with DHCS, CMS and provider directory submission requirements.

* Experience with NCQA accreditation.

Equivalent In lieu of degree: Will accept experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.

Preferred Qualifications:

Field of Study: Business Administration, Health Care Administration or related field of study.

Technology & Software Skills: High proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, and systems like a Provider Contracting and Credentialing Management (PCCM) system.

Certifications & Licenses: A valid and current Driver's License and Auto Insurance.

Competency Statements

* Management Skills - Ability to organize and direct oneself and effectively supervise others.

* Business Acumen - Ability to grasp and understand business concepts and issues.

* Decision Making - Ability to make critical decisions while following company procedures.

* Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.

* Interpersonal - Ability to get along well with a variety of personalities and individuals.

* Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

* Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

* Consensus Building - Ability to bring about group solidarity to achieve a goal.

* Relationship Building - Ability to effectively build relationships with customers and co-workers.

* Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

* Judgment - The ability to formulate a sound decision using the available information.

* Communication, Oral - Ability to communicate effectively with others using the spoken word.

* Communication, Written - Ability to communicate in writing clearly and concisely.

* Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.