San Francisco Health Plan

  • Provider Contract Specialist

    Job Locations US-CA-San Francisco
    Job ID
    2019-1636
    Category
    Operations
    Type
    Regular Full-Time
  • Overview

    You can make an impact to the San Francisco communities. as a Provider Contract Specialist. 

     

    The Provider Network Operations department (PNO) is committed to providing excellent service to all providers who provide care to SFHP members. PNO serves as the liaison between many internal departments and the provider network for identifying and resolving provider needs as they arise. Additionally, the department is responsible for the oversight and management of SFHP’s managed care contracting efforts.

     

    The Provider Contract Specialist will work directly with both external providers and internal customers as necessary to establish and maintain provider agreements and overall provider relationships.  This person will be a central point of contact or inter-organizational point of escalation to troubleshoot and/or assist in the resolution of contract, claims and similar reimbursement related issues.

     

    The Provider Contracts Specialist will assist the Contracts Manager and Director, PNO with drafting, negotiating, and implementing many of the Plan’s hospital and ancillary provider and out of network contracts. The Specialist will act as backup to both Contract Manager and Contracts Coordinator as needed.   

     

     

    WHAT YOU’LL DO

     

    • Initiate and draft contracts and other transaction documents such as contract amendments and Letters of Agreement (LOAs).
    • Successfully negotiate the terms and conditions of such documents.
    • Perform data analysis and collection in preparation for contract negotiation .
    • Prepare proposals, term sheets and other materials in connection with the contracting process.
    • Participate in the coordination and implementation of testing efforts involved in new and amended provider contract configurations in QNXT.
    • Establish and maintain a process for communicating and tracking contract terms and rates to internal and external customers.
    • Maintain effective working relations with plan providers, vendors and medical groups.
    • Facilitate any claims or UM disputes between ancillary providers and Claims or UM.
    • Work closely with the Plan’s in-network medical groups and ancillary providers to ensure quality and timely access for members.

     

    WHAT YOU’LL BRING

     

    • BA/BS in Social Sciences, Business or related field or equivalent work experience; or MA in Health Care Administration or related field desired
    • Prior experience in a managed care plan or medical provider organization is desired
    • Knowledge of managed care and Medi-Cal and other entitlement programs is preferred
    • 1 to 3 years of experience with provider contract negotiations and administration required
    • 1 to 2 years of experience with provider relations preferred
    • Detail oriented and organized with the ability to interpret policy and make decisions.
    • Basic to intermediate knowledge of the provider contracting process including concepts such as capitation, fee-for-service and reciprocity desired
    • Experience with QNXT or other health care information systems is preferred
    • Proficient with MS Office tools and applications including Access, Excel, Word, and Outlook is required
    • Ability to communicate effectively (spoken and written), give presentations and lead diverse groups

     

    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 under-served 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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