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. San Francisco Health Plan is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 142,000+ 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.
The Contract Specialist, under the general direction of the Director of Provider Network Operations works collaboratively with the rest of the Contracts and Provider Relations teams. The Contract Specialist may work directly with both external providers and internal customers as necessary to establish and maintain provider agreements and overall provider relationships. This person may also be called upon to troubleshoot and/or resolve contract related issues.
WHAT YOU’LL DO
- Initiates and drafts contracts and other transaction documents such as contract amendments and Letters of Agreement (LOAs).
- Successfully negotiates the terms and conditions of such documents.
- Performs data analysis and collection in preparation for contract negotiation .
- Prepares proposals, term sheets and other materials in connection with the contracting process.
- Participates in the coordination and implementation of testing efforts involved in new and amended provider contract configurations in QNXT.
- Establishes and maintains a process for communicating and tracking contract terms and rates to internal and external customers.
- Maintains effective working relations with plan providers, vendors and medical groups.
- Facilitates any claims or UM disputes between ancillary providers and Claims or UM.
- Works closely with the Plan’s in-network medical groups and ancillary providers to ensure quality and timely access for members.
WHAT YOU’LL BRING
- Prior experience in a managed care plan or provider organization is preferred
- Knowledge of managed care, Medi-Cal and other entitlement programs is preferred
- Ability to communicate effectively (spoken and written), give presentations and lead diverse groups
- Contracting negotiations and drafting experience is preferred
- Possesses a basic to intermediate knowledge of the provider contracting process including concepts such as capitation, fee-for-service and reciprocity
- Detail oriented and organized with the ability to interpret policy and make decisions
- Experience with QNXT or other healthcare information systems is preferred
- Proficient with MS Office tools and applications including Access, Excel, Word, Outlook is required
- BA/BS in Health Care, Business or related field with two years of work experience or MA/MS in Health Care Administration or related field with one year of experience is required
NOTE: This description is not intended to be construed as an exhaustive list of duties, responsibilities or requirements for the position. This position may change or assume additional duties at any time. The employee may be requested to perform different or additional duties as assigned.
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.