San Francisco Health Plan

  • Provider Contract Coordinator

    Job Locations US-CA-San Francisco
    Job ID
    2018-1414
    Category
    Operations
    Type
    Regular Full-Time
  • Overview

     

    POSITION SUMMARY

     

    The Provider Network Operations (PNO) department acts as the liaison between many internal departments and external customers by identifying and resolving provider and vendor issues as they arise. Additionally, the department is responsible for the oversight and management of SFHP’s managed care and vendor contracting functions.

     

    The Provider Contract Coordinator will duly support both the provider and vendor contracting functions carried out within PNO in an effort to meet the contracting and relationship management needs of the organization and assist in various projects to support the maintenance of the provider network.  The Coordinator will participate and/or lead small to medium sized projects that support both the provider and vendor contracting processes.

     

    This person will work collaboratively with all Plan staff as necessary to (a) support  provider contracting efforts, (b) execute one time Letters of Agreement, (c) assist with  maintenance of the provider and vendor contract database,  (d) assist in the creation and maintenance of the contract templates maintenance process, (e) provide general administrative support to the administrative contract management function.

     

     

    WHAT YOU’LL DO

     

    • Initiates and drafts contracts and other transaction documents such as Letters of Agreement (LOAs) using standard templates.
    • Assists in successfully negotiating terms and conditions of such documents as needed.
    • Assists in preparing proposals, term sheets and other materials in connection with the contracting process.
    • Maintains tracking system to monitor and report on LOAs and contract amendments.
    • Communicate internally with Provider Relations, Utilization Management, Claims and other departments as necessary.
    • Assists in maintaining a process for communicating contract terms and rates to Medical Management and Claims departments.
    • Maintains effective working relations with plan providers, vendors and medical groups.
    • Assists in facilitating any claims or UM disputes between ancillary providers and Claims or UM.
    • Assists in working closely with the Plan’s in-network medical groups and ancillary providers to ensure quality and timely access for
    • Participates and may lead training to internal staff on contracting efforts, needs, and process.
    • Responsible for monitoring and maintaining contract files, both electronic and paper.

     

    WHAT YOU’LL BRING

    • BA/BS in Business, Health Care or related field and/or two years of relevant work experience required

    • Prior experience in a managed care plan or provider organization is preferred
    • Knowledge of managed care and Medi-Cal and other health insurance programs is preferred
    • Contract negotiations and drafting experience is preferred
    • Ability to communicate effectively (spoken and written); knowledge and application of English grammar including composition, editing and proofreading skills
    • Detail oriented and organized with the ability to interpret policy and make decisions
    • Proficient with MS Office tools and applications including Access, Excel, Word, Outlook is required
    • Polished professional with the ability to communicate effectively both written and verbally to professionals at all levels of the organization
    • Ability to produce accurate and precise work, detect discrepancies and resolve discrepancies all while meeting deadlines
    • Ability to work effectively, independently, and as part of a team
    • Strong organization, time management and project management skills and multi-tasking abilities

     

    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.

     

    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.

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