Role Overview
As a Data Administrator, you will play a central role in maintaining the quality and integrity of healthcare data across systems. Your work directly supports compliance, care coordination, and strategic decision-making within a fast-paced health services organization.
Key Responsibilities
- Manage monthly and quarterly submissions of Enhanced Care Management (ECM) Report Template Files (RTF) and Outreach Transmission Files (OTF) to contracted health plans, ensuring all formats meet payer-specific requirements.
- Collect, verify, and merge data from internal platforms to maintain accurate records of member demographics, service dates, and case documentation.
- Monitor submission deadlines, confirm receipt with health plans, and resolve rejections promptly to prevent financial or compliance risks.
- Perform regular eligibility reviews to confirm member qualification for ECM, Medi-Cal, and related programs, updating records based on reassessments from care teams.
- Document re-qualification actions in alignment with audit and payer standards, ensuring transparency and traceability.
- Update member statuses in real time to support accurate resource planning and uninterrupted care delivery.
- Replicate Lead Care Manager (LCM) notes from TheraPlatform into SalesMate, ensuring a unified record of member interactions across platforms.
- Standardize note formatting and apply consistent tagging to improve reporting efficiency and data retrieval.
- Conduct routine audits to detect missing or inconsistent entries, working with care teams to correct discrepancies.
- Generate weekly summaries of member case statuses—active, pending, and closed—and distribute them to leadership for operational oversight.
- Identify trends in outreach completion, reassessments, and engagement levels, translating findings into clear insights for management.
- Produce and deliver reports tailored to department heads, sales teams, and executives, supporting data-informed planning and accountability.
- Review and update member profiles regularly to reflect current service status, discharge details, and transitions, ensuring alignment with actual care delivery.
- Flag data inconsistencies proactively and collaborate with clinical teams to resolve issues efficiently.
- Ensure all member records meet health plan compliance standards and remain audit-ready at all times.
- Generate recurring performance and compliance reports, tracking key metrics such as enrollment counts, service utilization, eligibility changes, and program engagement.
- Provide customized progress summaries to leadership and external partners to demonstrate program impact and adherence to requirements.
- Support internal audits and quality improvement initiatives by supplying accurate, timely, and well-documented data sets.
- Analyze demographic, economic, and healthcare usage patterns to identify opportunities for expanding community-based programs.
- Research local regulations, health plan coverage, and community needs to guide strategic outreach and program placement.
- Build and manage structured databases of potential partners, community events, and outreach opportunities.
- Verify the reliability of data sources to support leadership in making evidence-based decisions.
- Maintain a curated calendar of relevant conferences, networking events, and community activities aligned with organizational goals.
- Evaluate the strategic value of events based on target populations, partnership potential, and visibility.
- Coordinate event participation with internal teams, covering logistics, staffing, and materials.
- Track post-event engagement and outcomes to assess return on investment and inform future planning.
- Support system improvements by assisting with data migrations, workflow redesigns, and new tool implementations.
- Participate in special projects such as large-scale data audits or compliance reviews.
- Train new staff on data processes, system usage, and reporting standards.
- Collaborate with IT to resolve technical issues and enhance data workflows.
Qualifications
- Bachelor’s degree in data management, healthcare administration, information systems, or a related field—equivalent experience considered.
- Strong analytical, organizational, and problem-solving abilities.
- Clear and effective communication skills across executive, managerial, and cross-functional audiences.
Preferred Experience
- Background in healthcare data administration, regulatory reporting, or compliance.
- Familiarity with CRM platforms, reporting dashboards, and data entry tools—experience with TheraPlatform or SalesMate is advantageous.
- Knowledge of Medi-Cal, ECM, CalAIM, and health plan compliance processes.
Technology Environment
- TheraPlatform
- SalesMate
- CRM platforms
- Reporting dashboards
- Data entry tools
