The Provider Demographic Management (PDM) Coordinator is responsible for generating Health Plan notifications including adds, changes and terms. PDM Coordinator catalogs and tracks all changes and ensures key updates are completed accordingly. In addition, the PDM Coordinator will work directly with the PDM Specialist to ensure the accuracy of network provider information listed on the contracted health plans directories and websites. The PDM Coordinator will assist in maintaining accurate and updated provider matrixes and rosters on internal intranets as well as websites.
Essential Job Outcomes
Verify Health Plan directories and websites to ensure accuracy of provider information.
Assist PDM Specialist with maintaining departmental matrixes and provider rosters.
Assists other departments with health plan related issues, requests and questions related to provider information.
Responsible for 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 provider 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 Network Operations with the maintenance of ACO rosters and ensures daily changes are accurately updated within internal systems, e.g. ECHO.
Responsible for creating monthly rosters including, but not limited to the following networks: GNP, MCMG, Boeing, Worker’s Compensation, etc.
Responsible for the provider demographic verification and validation of Health Plan rosters
Perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability