Under direction of the Manager, Provider Relations, the Provider Data Specialist is responsible for ensuring the integrity and accuracy of San Francisco Health Plan (SFHP)’s provider data while working collaboratively with all internal and external stakeholders in an effort to meet and/or exceed all regulatory and industry provider data quality and accuracy standards. The Specialist will be a skilled user of the managed care system (QNXT) and must have excellent information systems skills.
WHAT YOU WILL DO
- Report and extract data for various reports and analysis
- Identify and initiate system improvements
- Assist Manager with the development and implementation of system maintenance standards
- Conduct audits to reduce errors and improve processes and performance
- Reconcile additions, changes, and termination notices from providers with SFHP’s core provider database
- Ensure the maintenance of current provider data
- Coordinate corrective activities to improve data and user experience
- Stay informed about the latest trends and developments in the provider data management field including new products and services through professional associations, industry conferences, training seminars and other information sources.
- Serve as representative on projects related to provider data management
WHAT YOU WILL BRING
- BA/BS in Business Administration, Health Care Administration, or related field preferred.
- Required minimum two years combined experience in provider credentialing, provider directory, and/or provider relations.
- Experience with writing audit reports and taking meeting minutes
- Experience with presentations and leading diverse groups
- Appropriate industry and subject matter certifications preferred
- Demonstrated working ability using a total managed care system
- End-user experience with CRM or demographic databases and data retrieval tools strongly preferred
- Very strong MS Office skills
- SQL queries experience highly desireable
- Strong experience in Excel (i.e. pivot tables) preferred
- Detail-oriented and organized with an understanding of provider information systems management
- Knowledge of industry standard provider credentialing processes and software systems.
- Knowledge of regulatory requirements and regulations (DHCS, DMHC, NCQA, etc.) related to provider credentialing.
- Knowledge of managed care and Medi-Cal and other state-sponsored health programs strongly preferred
- Ability to communicate effectively (spoken and written)
- Some experience with presentations and leading diverse groups
- Versatility, flexibility, and professionalism.
- Demonstrated ability to learn quickly
- Strong computer and Web aptitude, solid understanding of how to use common platforms and applications
- Ability to work with multiple departments within the organization and external clients
- Experienced with electronic file management, SharePoint preferred
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.