San Francisco Health Plan

  • Provider Relations Specialist

    Job Locations US-CA-San Francisco
    Job ID
    2019-1612
    Category
    Operations
    Type
    Regular Full-Time
  • Overview

     

    The Provider Relations Specialist will serve as a liaison to SFHP’s network of providers, hospitals, and health systems, including medical groups, independent clinics, mental health professionals, and ancillary providers.  This person will be an integral part of the Provider Relations team and will provide hands-on, high level, exemplary customer service to all providers.  The ideal candidate will work well in a fast-paced, team driven, metric and deliverable focused environment and will be responsive to the fluctuating needs of the organization, the providers, and the regulatory bodies which govern its work.

     

    The Specialist will represent SFHP in the provider community, which will include a variety of tasks and responsibilities including but not limited to handling provider questions and issues, as well as representing the department and the Plan at both internal and external meetings. The Specialist assists providers with logistics and set-up of trainings on the rights, resources and responsibilities of a provider in Medi-Cal managed care.

     

    WHAT YOU’LL DO

    • Serve as the first line primary contact to SFHP's provider network.
    • Act in the capacity of primary provider liaison and SFHP subject matter expert by answering and solving a broad range of questions and  problems in an efficient and timely manner with an emphasis on long-term relations, customer service and professionalism.  Some examples include:
      • Claims payment disagreements
      • EDI delegation and requirements translation
      • Conducting regular site visists with key providers
    • Communicate clearly and concisely with provider leadership, individual providers, and their support staff.
    • Represent the Provider Relations department at internal cross-functional meetings.
    • Participate in, and occasionally lead, departmental and organizational projects.

     

    WHAT YOU’LL BRING

    • Bachelors degree in Social Sciences, Business or a related field, or equivalent work experience in a health care environment.
    • Prior experience in a managed care setting, provider organization or with health policy.
    • Exceptional diplomacy, communication and collaboration skills.
    • Experience with presentations and leading diverse groups.
    • Ability to work with multiple departments within the organization and external clients.
    • Desire to expand your health plan operational knowledge base.
    • Demonstrated working ability using a total managed care system.
    • Experienced with electronic file management, SharePoint preferred.

     

    ABOUT US

     

    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 140,000+ 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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