San Francisco Health Plan

  • Provider Credentialing Coordinator

    Job Locations US-CA-San Francisco
    Job ID
    2019-1632
    Category
    Operations
    Type
    Regular Full-Time
  • Overview

    You can make a difference in San Francisco! At San Francisco Health Plan (SFHP), we strive to improve health outcomes of the diverse San Francisco communities by helping to ensure low-income San Franciscans have access to high quality health care.

     

    The Provider Credentialing Coordinator is responsible for obtaining, verifying and maintaining the credentials of SFHP’s network of providers. This position will be primarily responsible for ensuring SFHP compliance with the credentialing process of individual practitioners, ancillary and hospital providers. The Coordinator will work collaboratively with the Health Improvement and Compliance departments to support the organizational goals for oversight and monitoring of groups which are delegated to perform credentialing on behalf of SFHP.

     

    WHAT YOU WILL DO

    • Use and maintain the Health Plan’s comprehensive Credentialing Program, including a comprehensive work plan of credentialing activities.
    • Process practitioners’ and ancillary provider applications by conducting primary source credentialing verification and creating organized, clean and clear evidence files.
    • Perform the necessary and sufficient technical procedures of a complete credentialing process, including accurate tracking of provider credentials and accreditation in a complex database.
    • Monitor the state of provider credentials and accreditation in this database, anticipating the need for any renewals, updates, and recertification.
    • Ensure all practitioners complete the New Provider Orientation regarding the rights and obligations of a provider in the Medi-Cal program.
    • Interpret and advise the Delegation Oversight department regarding reports from groups delegated to perform credentialing such as Kaiser, VSP, Delta Dental, and CBAS.
    • Assist in the execution of SFHP policy and procedure for the management of provider corrective action plans.
    • Assist with oversight-audit activities (scheduling, communication with non-delegated groups and internal stakeholders, evaluating delegated groups against established credentialing standards).
    • Monitor non-delegated providers responses to oversight audit requests for corrective action to ensure compliance with requirements. Ensure that follow up with non-delegated providers is documented.
    • Represent Provider Relations Department at internal cross-functional meetings.
    • Represent SFHP at external meetings as needed.

     

    WHAT YOU WILL BRING

    • BA/BS in Social Sciences, Business or related field; or equivalent work experience in a health care environment
    • Prior experience in a managed care setting, provider organization, or with health policy is preferred
    • Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator (CPMSM) is preferred
    • Strong MS Office skills: Word, Excel, Access, PowerPoint, Outlook; experienced with electronic file management, SharePoint preferred
    • Knowledge of managed care and Medi-Cal and other state-sponsored health programs preferred
    • Excellent communication skills with a variety of professionals, including physicians and other health providers, administrators and others; experience with presentations
    • Detail-oriented and organized with the ability to interpret policy and make decisions
    • Demonstrated working ability using a total managed care system desired

     ABOUT US

     

    Established in 1994, 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.

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