Data Administrator

Key Responsibilities

Health Plan Compliance Submissions

• Oversee the monthly and quarterly submission of Enhanced Care Management (ECM) Report Template Files (RTF) and Outreach Transmission Files (OTF) to all contracted health plans.
• Gather, validate, and consolidate data from multiple internal systems, ensuring accuracy of member demographics, service dates, and case notes.
• Ensure all submissions meet health plan-specific formatting and regulatory requirements to maintain compliance.
• Monitor submission timelines, confirm receipt with health plans, and troubleshoot errors or rejections quickly to avoid penalties.

Member Eligibility and Authorization

• Conduct recurring eligibility checks to confirm members remain qualified for ECM, Medi-Cal, and other service programs.
• Partner with case managers to reassess member needs and adjust service enrollments accordingly.
• Document all re-qualification activities in compliance with audit standards and payer expectations.
• Update member statuses promptly to ensure accurate resource allocation and continuity of care.
• Manage the end-to-end process for obtaining initial authorizations and subsequent reauthorizations through various provider portals.
• Track the status of all authorizations, maintaining detailed records of approvals, denials, and pending renewals.

System Data Integrity

• Maintain a consolidated and reliable view of all member touchpoints by duplicating Lead Care Manager (LCM) notes from TheraPlatform into SalesMate.
• Standardize note formatting and apply appropriate tags or categories for efficient retrieval and reporting.
• Perform regular audits to identify missing or incomplete data entries and resolve discrepancies with care teams.
• Ensure that data captured across platforms supports continuity of care and enhances leadership visibility.

Leadership Reporting

• Compile weekly updates on member statuses, including active, pending, and closed cases, and distribute to executive and leadership teams.
• Track and highlight trends such as outreach completion rates, reassessment activity, and engagement levels.
• Translate raw data into actionable insights that enable leadership to make timely, data-driven decisions.
• Deliver clear reports to multiple stakeholders, including department heads, sales teams, and executive leadership.

Member Profile Oversight

• Review and update member profiles regularly to ensure active/inactive statuses are correct and align with real-time service delivery.
• Confirm discharge reasons, service end dates, and member transitions are fully documented for compliance.
• Flag discrepancies proactively and work directly with care teams to resolve errors.
• Maintain health plan compliance standards by ensuring member record integrity and audit readiness.

Operational Reporting

• Produce recurring weekly and monthly reports to monitor organizational performance and compliance.
• Track key indicators such as member counts, service utilization, eligibility changes, and program engagement rates.
• Provide tailored progress reports to leadership or external partners to demonstrate accountability.
• Support internal audits and quality improvement initiatives by providing clear, accurate, and timely data.

Research & Expansion Insights

• Aggregate demographic, economic, and healthcare utilization data to identify new regions for community-based program expansion.
• Conduct in-depth research on local regulations, health plan coverage, and community needs to ensure successful placement.
• Build and maintain structured databases of potential partners, community events, and opportunities for organizational outreach.
• Validate data sources for accuracy and reliability to support leadership in making informed, evidence-based decisions.

Event Planning & Outreach Support

• Research and curate a calendar of community events, conferences, and networking opportunities aligned with organizational goals.
• Assess the strategic value of events based on target populations, potential partnerships, and visibility opportunities.
• Partner with internal teams to coordinate event participation, including logistics, staffing, and materials.
• Track outcomes and engagement metrics post-event to evaluate return on investment and guide future planning.

Other Duties as Assigned

• Support evolving priorities by assisting with data system implementations, migrations, and workflow redesigns.
• Participate in special projects such as large-scale data audits or compliance-focused reviews.
• Help onboard and train new staff in data procedures, system use, and reporting protocols.
• Work cross-functionally with IT to troubleshoot system issues and optimize workflows.