Provide advisory and technical services to all of the health-plan’s contact center organizations (Member Services, Health Services, Claims, PR, and Admin) in the areas of operations, system enhancement & configuration, report generation, knowledge management, and training. Conduct business and technical requirements analysis, testing, and execution in support of the development of PHC’s contact center systems enhancements and reports. Develop and maintain an understanding of PHC’s contact center systems and reporting tools as an administrator and a user. Develop and deliver custom daily, weekly, monthly, quarterly, and yearly reporting with contact center metrics,...

The Senior Healthcare Data Analyst I contributes to the overall success of the organization by developing analytic solutions that support activities related to health services utilization management, care coordination, quality improvement and population health. Through analyzing patient claims, member enrollment, and other data, the Senior Healthcare Data Analyst

To design, support, and provide strategic planning of the Business Intelligence solution across the enterprise. Manages deployment, maintenance, and support of Business Intelligence tools and reports. Analyzes, creates, documents, tests, maintains, troubleshoots, and promotes the Business Intelligence environment.

Responsible for the development of all processes necessary to complete all phases of the Enterprise Data Warehouse (EDW). This includes source identification, data collection, data transformation, normalization, rule administration, error detection and correction, data consolidation, data storage, data distribution, schema mapping, data enrichment, and data governance.

Train examiner and customer service level I staff on all related claim types for all PHC lines of business using AMISYS Advance system and Claims Operating Instruction Memorandums.

To establish and maintain excellent relationships with the provider network in a specific geographic region, including healthcare practitioners, office staff, and administrators. Works closely to identify and resolve complex issues, provides education and staff training. Provides service and education via onsite visits and telephone. Assists providers with understanding Partnership HealthPlan of California's policies and procedures and assists with resolving issues that arise.

In collaboration with Care Coordination team members, this position provides support and guidance to HealthPlan members referred to the Care Coordination Department for Case Management services and programs. The Health Care Guide I works closely with members, families, providers, community agencies, and the interdisciplinary care team to assist in coordination of benefits in a timely and cost-effective manner, while connecting members to available internal and external resources.

The Accountant II-Cash Management (Accounts Receivable) position will be a key member of the cash management team and is responsible for various cash and invoicing functions, including the invoicing and posting of cash receipts for Leased Tenants, Wellness and Recovery Drug Medi-Cal Counties and other entities as required. This position will be the main point of contact for inquiries related to such invoices.   This position will possess excellent communication skills as they will not only respond to billing inquiries but will also manage the Cash Management Helpdesk and address inquiries on a timely basis.

To assist in developing and maintaining HIPAA compliant ANSI X12 EDI healthcare transactions for PHC. Responsibilities include programming the federal and/or state mandated transactions and other EDI applications using tools & technologies such as EDI Translators, Microsoft SSIS/SSRS package solutions, Microsoft Transaction SQL blocks and Oracle PL/SQL.