The successful candidate will work with a high degree of autonomy to provide support and lead a broad range of activities where you will flex your excellent judgment and decision-making abilities. In this role, you will have the opportunity to grow as you demonstrate your extensive knowledge of State health care programs and requirements, and gain additional knowledge in the areas of health care compliance, regulations and new health care reform initiatives at the local, as well as statewide levels (e.g. Medi-Cal expansions and children’s health programs). You must be extremely professional, organized, be able to demonstrate high standards, integrity, confidentiality, enjoy interacting with people at all levels, and thrive in a fast-paced environment.
WHAT YOU WILL DO
- Provide timely responses to State inquiries, including ad hoc inquiries, State Fair Hearings, Independent Medical Review requests and Consumer Complaints.
- Analyze Compliance Program reports for trends and and identify the need for corrective action.
- Oversee and conduct internal audits as assigned.
- Coordinate audits by governmental agencies.
- Train staff on various aspects of new legislation, contracts, compliance, HIPAA and other regulations.
- Lead organizing, tracking and responding to subpoenas and liens for all SFHP lines of business.
- Lead the implementation of SFHP's business continuity plan.
- Serve as one of the department liaisons with state agencies.
- Analyze and coordinates the implementation of new regulations and legislation as assigned.
- Ensure smooth functioning of assigned area of responsibility.
- Coordinate activities between departments as relevant to the Compliance and Regulatory Affairs department.
- Appropriately refer substantive questions / key business issues to others and provides timely follow-up to ensure resolution on behalf of the manager.
- Assess problems and develops solutions following general policies and procedures.
- Perform special assignments for the manager, which requires researching and collecting information needed to complete projects or reports; locating, analyzing and summarizing data to identify variances and provide recommendations; and producing reports requiring specialized content knowledge, which may be the basis of significant decisions.
- Assist with department budget, including processing invoices and variance reports.
WHAT YOU WILL BRING
- Bachelor’s degree or equivalent combination of education and work experience
- JD preferred
- Healthcare Compliance Certification preferred
- Five plus years of administrative assistant or specialist experience, ideally in a health plan environment
- Strong working knowledge of State program regulations and HIPAA
- Superior critical thinking and problem solving abilities
- Exceptional communication abilities and organization skills
- Advanced proficiency with MS Office applications (Word, Excel, PowerPoint)
WHO WE ARE
Established in 1997, San Francisco Health Plan (SFHP) is a an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 145,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.
San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.