Job Listings

Our Mission Is Our Passion
Founded in 1997, San Francisco Health Plan is an award-winning health care organization created by, and for, the residents of San Francisco.  

Our mission?
To provide superior, affordable health care that emphasizes prevention while promoting healthy living. We strive to improve the quality of life for the residents of San Francisco and to support the providers who serve them. What makes SFHP different?  Our people do. Every day, we are doing innovative work to help transform healthcare options in San Francisco and the lives of over 140,000 members!  There hasn't been a more exciting time to join SFHP as we continue to improve our award winning model for healthcare reform.


Our CEO - Mission and Vision      

             



Let our mission become your passion – come explore our career opportunities below!

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In this position you will be part of a highly collaborative and dynamic team, responsible for the overall project planning, execution, and implementation of medium to large scale technology-enabled solutions to key SFHP internal stakeholders. You will lead the formulation and definition of systems scope based on both business user needs and an understanding of the business systems and industry as it relates to those projects.

 

WHAT YOU WILL DO

  • Provide project leadership using the SDLC for medium to large enterprise-wide projects with a focus on IT infrastructure and security.
  • Perform QA testing, including planning and executing unit, integration, and acceptance testing, in support of timely, quality project implementation.
  • Develop Functional and Design Specifications, including use cases, data flows in support of timely, quality project implementation.
  • Perform analysis in support of timely, quality project implementation.
  • Provide end-user training for implemented systems/processes along with accompanying training manuals or user guides.
  • Mentor and coach more junior PM/Business Systems Analysts.

 

WHAT YOU WILL BRING

  • A degree from a four-year college (e. g., BS).
    • Masters in Business Administration, Health Administration, Public Health preferred
    • Prior experience at a healthcare organization, ideally at a managed health plan
  • 3-5 years of experience as a IT Project Manager and/or Business Systems Analyst in a healthcare environment.
  • Project Management certification preferred (i.e. PMP or Six Sigma.
    • QNXT configuration and testing experience preferred (i.e., prototyping, enhancements, unit testing and system upgrades)
    • Experience using MicroStrategy BI tool preferred
  • Experience with process design and documentation methodologies, and design and production of quality deliverables, process and use case modeling, business case development.
  • Understanding of information systems, business processes, the key drivers and/or measures of success for the healthcare industry, particularly the Payor market, managed care and State-sponsored programs.
  • 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 project management, leadership & meeting facilitation skills
  • Strong analytical skills and problem solving skills with the ability to formulate and communicate recommendations for improvement.

 

WHO WE ARE

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.

Job ID
2017-1219
Category
Information Technology Services

San Francisco Health Plan (SFHP) is the public Medi-Cal managed care plan for San Francisco serving 135,000 Medi-Cal members. SFHP also acts as a Third-Party Administrator to support the SF Department of Public Health for Healthy Kids, Healthy San Francisco and the SF City Option.

Key to our success at SFHP is the support and assistance we provide to our members and the community at our Service Center. The Enrollment Coordinator will serve a vital role in this success by serving thousands of clients each year, helping them to navigate complex health insurance rules, processes and programs

 

As an Enrollment Coordinator, you will gain front-line experience helping members of the San Francisco community apply and enroll in health coverage. You will learn and master the systems and applications for at least 6 health coverage programs and be able to accurately and effectively screen a client to determine the best health coverage option(s) for their family. An Enrollment Coordinator will undergo extensive training and obtain certifications in eligibility rules and application processes for Medi-Cal, CalFresh, Covered California, Healthy San Francisco, SF City Option, and the Healthy Kids programs.

 

The ideal candidate for this position will possess strong customer service skills, be highly organized, inquisitive and flexible in a health care enrollment environment that is constantly changing. The candidate will have demonstrated experience in following and adhering to policy and procedure, skilled in distilling or translating program rules and regulations into easily understandable and practical terms for our clients and applicants.

 

WHAT YOU'LL DO

  • Assists potential applicants, existing members and participants with eligibility and enrollment into health coverage.
  • Provides counseling and education about health insurance and health coverage options for clients and their families in a fair, accurate, impartial, and culturally sensitive manner.
  • Maintains program expertise, training requirements, and certifications for all application assistance services offered by the SFHP Service Center, including Medi-Cal, Covered CA (Medi-Cal Managed Care Plan Enroller training and certification), Healthy San Francisco (HSF Application Assistor training), and Healthy Kids (HK Application Assistor training).
  • Accurately determines program eligibility and documents all interactions and encounters with applicants in the appropriate system.
  • Conducts outreach calls and schedules in-person appointments with potential applicants and existing SFHP members and participants renewing coverage.

 

WHAT YOU'LL BRING

  • Bachelor’s degree or equivalent experience desired.
  • Bilingual ability in Spanish or Cantonese desired.
  • Exemplary interpersonal and customer service skills. 
  • Ability to communicate program rules and policies in clear, understandable terms accurately and professionally to various audiences and individuals of diverse backgrounds.
  • Ability to comprehend, interpret and comply with complex rules and regulations, including privacy and compliance standards, program eligibility rules and processes. 
  • Possesses superior interviewing and communication skills to ensure applicants understand their health care coverage choices, costs or other relevant information and are screened and enrolled in the appropriate health coverage program.
  • Demonstrates consistent good judgment, organization and prioritization skills, and time management skills. 
  • Ability to assess, escalate, think critically and prioritize cases or issues to management.
  • Strong computer skills, including high proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint).
  • Experience with eligibility applications such as One-e-App, CalHEERS, or mybenefitsCalWIN is desired.


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.

 

Job ID
2017-1218
Category
Policy Development & Coverage Programs

In this senior position you will report to, and serve as, a trusted adviser to the Chief Operations Officer (COO).  You will partner with other department leadership teams to ensure programs and projects are effectively measured, assessed & continuously improved using standardized tools and methodologies.

 

DEPARTMENT SUMMARY

 

The Performance and Process Improvement (PPI) Department is a service department within SFHP, supporting core managed care operations to optimize performance. The Director, PPI drives efficiency improvements by directing the continuous process and performance improvement program.  The Director supports the effective and timely execution of enterprise-wide projects.  Responsibilities include the following functions: quality assurance & continuous improvement, enterprise project management, QNXT configuration and user acceptance testing, coding support, operations reporting and Trizetto/Cognizant vendor management.

 

WHAT YOU’LL DO

  • Responsible and accountable for the performance of all PPI functions and teams
  • Implement cross training plans to ensure continuous learning and the reduction of single threads across all PPI Teams
  • Provide oversight of and direction to the Enterprise Project Management Office (EPMO) unit
  • Direct SFHP Operations’ quality assurance program, which supports organizational goals & priorities as well as the requirements of regulatory agencies
  • Implement and monitor process and continuous improvement activities:
    • Work closely with Operations Department Managers and Directors to ensure high quality operational results and supports successful delivery of operational priorities
    • Consult & participate in performance improvement teams using a variety of methodologies
    • Consult on data analysis techniques & evaluate trends to identify potential opportunities for improvement
  • Represent the PPI Department and at times, all of Operations, on organizational committees and workgroups
  • Provide leadership and business expertise on various projects and processes
  • Ensure effective cross-functional communication
  • Ensure that PPI department staff is informed of organization-wide information and decisions
  • Support COO in planning, developing, implementing, managing and refining comprehensive annual operations business plan
  • Develop and manage fiscal year budgets, using your resourceful nature and detail orientation to maintain fiscal standards

WHAT YOU’LL BRING

  • A Bachelor's degree (Masters degree preferred)
  • Five to ten years in healthcare operations
  • 10 years previous management experience (Chief of Staff experience a plus)
  • Experience designing, developing, and implementing quality improvement programs, and/or a Project Management Office, continuous process improvement teams, operations reporting and analytics and business system configuration
  • Experience in managed care operations, Medi-Cal/MediCaid, quality assurance and process improvement
  • Strong experience/understanding of Six Sigma
  • Superb written and oral communication skills
  • Strong presence – ability to effectively engage with a wide range of stakeholders
  • Exceptional cross-organization and coordination skills
  • Ability to resolve conflict and drive solutions
  • Demonstrated knowledge of governmental and other regulatory standards, requirements, and guidelines related to quality improvement, such as NCQA, Knox-Keene Act, Federal HMO Act, CMS Conditions of Participation, Title 22, Cal-OSHA, HIPAA and Medi-Cal/Medicaid and Medicare regulations and standards

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 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.

Job ID
2017-1207
Category
Operations

POSITION SUMMARY

This mission critical position will work closely with a team of business systems analysts to design, implement and maintain business applications and data automation processes to further support our members and providers.  The individual will design and create object-oriented solutions within the Microsoft .NET Framework, including SQL stored procedures and user-defined functions.  You will leverage your strength in documentation to author functional and technical specifications and serve as a subject matter expert for the common codebase.

 

WHAT YOU WILL DO

  • Work with IT project manager/business systems analyst and business users to clarify and document requirements and business rules.
  • Drive the transistion from business requirements to technical design.
  • Design, develop, implement, and deploy applications and batch processes.
  • Create and execute unit test plans and systems integration testing based on system and validation requirements.
  • Troubleshoot, optimize, and tune applications and batch processes.
  • Document all work-product, per SFHP’s best practices and standards.
  • Maintain existing code and fix bugs whenever needed.
  • Ensure smooth functioning of our development, QA, and production environments for SFHP business applications.
  • Collaborate with various functional business units to gather business and technical requirements.
  • Conduct data analysis; identify issues and recommend and implement solutions.

 

WHAT YOU WILL BRING

  • Bachelor’s degree in Computer Science or an equivalent combination of education and experience.
  • 5+ years of .NET developer experience using Visual Studio.
  • 5+ years of advanced SQL Server development skills (complex SQL queries, complex store procedures and user-defined functions in SQL Server 2005).
  • 5+ years of proven ability in application development, ideally with one or more CLR languages, preferably C# and/or VB.NET.
  • Strong experience with Microsoft .NET Framework (version 3.5) and ASP.NET.
  • Experience in data analysis and data modeling (particularly OLTP design, 3rd normal form).
  • Familiarity with industry standard health data code sets such as ICD-9/ICD-10, CPT/HCPCS, revenue codes, and NDC (Pharmacy).
  • Familiarity with EDI/X12 file formats and other industry standards.

 

ABOUT SFHP

 

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.

Job ID
2017-1197
Category
Information Technology Services

 

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 (SFHP) is the public Medi-Cal managed care plan for San Francisco serving 135,000 Medi-Cal members. SFHP also acts as a Third-Party Administrator to support the SF Department of Public Health for Healthy Kids, Healthy San Francisco and the SF City Option.
The Coverage Programs Coordinator plays a vital role supporting the operations and administration of the Healthy Kids (HK) Program at the San Francisco Health Plan. Healthy Kids is a subsidized health insurance program sponsored by the San Francisco Department of Public Health (SFDPH) for uninsured children living in San Francisco.

 

Summary:


As the Coverage Programs Coordinator, you will gain valuable experience supporting a wide range of activities for the Healthy Kids program, including assisting with applications, eligibility, customer service, communications, reporting and more. You’ll work closely with the Coverage Programs team and other SFHP departments to help manage the program and play a pivotal part in serving Healthy Kids families.

The ideal candidate for this position will possess strong customer service skills, be highly organized and enjoy problem solving. The candidate must also be flexible, and have the ability to coordinate and collaborate well in a fast paced healthcare environment that is consistently changing. This is a great opportunity for someone interested in learning how local public health insurance programs are administered and operate.

 

What You’ll Do:

 

  • Assist in the review and processing of Healthy Kids applications and eligibility.
  • Research and resolve Healthy Kids eligibility issues, which may require responding to applicants, members or provider inquiries by phone and email. 
  • Conducts outreach calls, schedules in-person appointments and provides assistance to potential applicants and existing Healthy Kids members.
  • Coordinate resolution of operational issues with external partners and/or other SFHP departments.
  • Update dashboards and produce weekly/monthly/quarterly reports on program activities which track and monitor trends
  • Maintain documentation including desktop procedures and process flows that explain daily operations.
  • Provide administrative support to the Coverage Programs team including scheduling or coordinating meetings, documenting meeting minutes, and/or completing project tasks.

 

What You’ll Bring:

 

  • Bachelor’s degree or equivalent work experience.
  • Bilingual ability in Spanish or Cantonese desired
  • Prior work experience in a health care environment strongly preferred. 
  • Strong computer skills and proficiency with MS Office Suite (Word, Excel, PowerPoint, Outlook)
  • Proficient with electronic file management
  • High attention to detail and willingness to assist at all levels in order to ensure on time and accurate deliverables.
  • Knowledge of San Francisco health coverage programs including Medi-Cal and Covered California preferred, but not required.
  • Strong analytical and critical thinking skills


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.

 

PM 17

Job ID
2017-1194
Category
Policy Development & Coverage Programs

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 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.

 

POSITION SUMMARY

 

The Claims Analyst is accountable for accurate and timely adjudication of claims transactions utilizing edit queues, provider inquiries, refunds, as well as researching and analyzing to determine root causes to streamline the Claims Department’s processes. This position is responsible for recoveries, stop loss reinsurance, reimbursements and processing claims when needed. As part of the team, the analyst must keep current on claim processing procedures and produce a quality and timely work product.

WHAT YOU’LL DO

 

  • Analyze claim issues from identification to resolution. This entails: Identifying claims processing anomalies and offer solutions to address; completing root cause analysis for claims that are not processed accurately; identifying system or process deficiencies and offer suggestions for corrective actions; participating and providing feedback on claims system configuration testing; researching claim errors or inaccurate claim payments and identifying fixes.
  • Through analysis and process improvement, assist with accuracy, timely research, and adjudication of claim recoveries and overpayments, including: Coordination of benefits/other health coverage, overpayments (provider refunds) and reimbursement requests, refunds and retro-terminations.
  • Lead distinction between complex and non-routine claims processing by utilizing a variety of claims pricing tools for complex manual pricing of claims, interpret complex provider contracts to determine claims payments.
  • Represent the claims department as a subject matter expert and provide input to department and cross functional meetings.
  • Conform to established standards of performance for quality and timeliness.
  • When needed, keep the department’s claim inventory current and clear edit queues by process claims according to verification of eligibility, interpretation of program benefits and provider contracts to include manual pricing.
  • Review claims for missing or incomplete information; requesting additional information needed to complete adjudication of claims.
  • Review claims for necessity, limitations and exclusions based on claims policies and procedures and document in claims notes to support payments or decisions.
  • Determining the level of reimbursement based on established criteria and defined provisions.
  • Manage stop loss/reinsurance.
  • Determine and process overpayments (provider refunds) and reimbursement requests.
  • Ensure that the remit message provides the necessary explanation of payment for the provider
  • Reprocess /adjust claims when necessary.
  • Assist with service to Providers; handle provider calls promptly and courteously regarding claims status, billing and payment issues, disputes, etc.
  • Help with Provider Dispute Resolutions:
    • Responding to provider disputes in a timely and accurate manner.
    • Researching provider disputes to ensure appropriate resolutions.
    • Adjudicating claims that are over-turned thru the PDR process
    • Maintaining and updating the Provider Dispute Log.
    • Notifying manager of delay reasons that may affect timeliness of processing.
  • Work directly with provider groups and Provider Relations to resolve complex claims processing problems/issues.
  • Manage special projects within the department such as coordinating audit request
  • Maintain current desk level procedures for claims processing
  • Create an up-to-date inventory and log and monthly recovery reports where statistics are required for further analysis and monitoring by management personnel.
  • Document efforts to collect reimbursement.
  • Identifying trends in recoveries that require management intervention
  • Recognizing and documenting system issues, and working with manager and ITS to resolve
  • Keeping abreast of the changes in Medi-Cal regulations, program policies and current processing procedures.
  • Working with the Claims team to ensure consistent and accurate adjudication.


WHAT YOU’LL BRING

 

  • Minimum of 5 years prior work experience in claims operations environment in health care insurance business with 2 years working as an analyst
  • High school diploma; college degree preferred
  • Demonstrated depth of knowledge and experience in medical claims procedures, processes, governing rules and all aspects of claims adjudication including solid knowledge of CPT/HCPCS, ICD-9 claims coding and medical terminology
  • Knowledge of managed care and Medi-Cal reimbursement
  • Solid understanding of standard claims processing systems and claims data analysis
  • Excellent communication skills; verbal and written
  • Strong MS Office skills (Word, Excel, PowerPoint)
  • Hands-on working knowledge and background using claims processing system(s). QNXT application (V. 4.81 or later) experience preferred
  • Detail oriented with problem-solving abilities; maintain confidentiality
  • Strong organization, time management and project management skills and multi-tasking abilities
  • Excellent qualitative and quantitative abilities
  • Ability to handle detailed work, work with varying types of data and


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.

Job ID
2017-1187
Category
Operations

POSITION SUMMARY 

The successful candidate will work with a high degree of autonomy to provide support and lead a broad range of activities where you will flex your excellent judgment and decision-making abilities.  In this role, you will have the opportunity to grow as you demonstrate your extensive knowledge of State health care programs and requirements, and gain additional knowledge in the areas of health care compliance, regulations and new health care reform initiatives at the local, as well as statewide levels (e.g. Medi-Cal expansions and children’s health programs). You must be extremely professional, organized, be able to demonstrate high standards, integrity, confidentiality, enjoy interacting with people at all levels, and thrive in a fast-paced environment. 

           

WHAT YOU WILL DO

  • Provide timely responses to State inquiries, including ad hoc inquiries, State Fair Hearings, Independent Medical Review requests and Consumer Complaints.
  • Analyze Compliance Program reports for trends and and identify the need for corrective action.
  • Oversee and conduct internal audits as assigned.
  • Coordinate audits by governmental agencies.
  • Train staff on various aspects of new legislation, contracts, compliance, HIPAA and other regulations.
  • Lead organizing, tracking and responding to subpoenas and liens for all SFHP lines of business.
  • Lead the implementation of SFHP's business continuity plan.
  • Serve as one of the department liaisons with state agencies.
  • Analyze and coordinates the implementation of new regulations and legislation as assigned.
  • Ensure smooth functioning of assigned area of responsibility.
  • Coordinate activities between departments as relevant to the Compliance and Regulatory Affairs department.
  • Appropriately refer substantive questions / key business issues to others and provides timely follow-up to ensure resolution on behalf of the manager.
  • Assess problems and develops solutions following general policies and procedures.
  • Perform special assignments for the manager, which requires researching and collecting information needed to complete projects or reports; locating, analyzing and summarizing data to identify variances and provide recommendations; and producing reports requiring specialized content knowledge, which may be the basis of significant decisions.
  • Assist with department budget, including processing invoices and variance reports.

 

 WHAT YOU WILL BRING

 

  • Bachelor’s degree or equivalent combination of education and work experience
    • JD preferred
    • Healthcare Compliance Certification preferred
  • Five plus years of administrative assistant or specialist experience, ideally in a health plan environment 
  • Strong working knowledge of State program regulations and HIPAA
  • Superior critical thinking and problem solving abilities
  • Exceptional communication abilities and organization skills
  • Advanced proficiency with MS Office applications (Word, Excel, PowerPoint)

 

 

WHO WE ARE

 

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.

 

Job ID
2017-1172
Category
Compliance and Regulatory Affairs

 

POSITION SUMMARY

 

In this role, you will be responsible for liaisng with key business area stakeholders to understand thier needs and guide those business areas through application configuration - this includes project planning, execution, and implementation of changes to our business processes and applications as well as ensuring accurate, timely, and efficient configuration of those business applications.

 

WHAT YOU'LL DO

  • Perform implementation and configuration activities including prototyping, analysis, system configuration, operational implementation and process documentation.
  • Recommend and implement configuration changes to improve the overall efficiency of system processing.
  • Work cross-functionally to deliver system functionality to support streamlined and efficient processes.
  • Work in conjunction with UAT and end-users as needed to develop and execute appropriate test plan to verify configuration changes work as intended.
  • Develop and recommend operational processes and /or process improvements.
  • Document functional specifications for system solutions and enhancements to existing business systems.
  • Communicate results through written documents and maintain configuration database.

WHAT YOU'LL BRING

  • 3+ years of experience as a Business Systems Analyst and/or Configuration Analyst.
  • A Bachelor’s degree(e. g., BS), or an equivalent combination of education and work experience.
  • QNXT configuration and testing experience (e.g. prototyping, enhancements, unit testing and system upgrades).
  • Exceptional understanding of health care claims processing and data sets such as ICD-9/10 and CPT/HCPCs, provider contracts and benefits.
  • Prior experience at a healthcare organization.
  • Superior collaborative abilities and communication skills.

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 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.

 

Job ID
2017-1080
Category
Operations

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 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.

 

POSITION SUMMARY

 

The Manager is responsible for directing and managing all enrollment services provided at the San Francisco Health Plan’s (SFHP) Service Center. SFHP is a Medi-Cal managed care plan with over 130,000 Medi-Cal members, and provides Third Party Administrator (TPA) services to the San Francisco Department of Public Health for Healthy San Francisco (HSF), the SF City Option program and the Healthy Kids (HK) program.

The position oversees a team (10-12) providing application and enrollment services to SFHP members, program enrollees and clients seeking health-related services in multiple languages. The Manager is responsible and accountable for all day-to-day Service Center activities and operations, as well as direction, decision making and measurement of service levels to ensure high quality service.

The candidate for this position will be highly organized with proven experience in an operational client-facing and service-oriented role. She/He will possess strong verbal and written communication skills and be experienced in establishing and enforcing operational policies and processes that align with regulatory requirements, as well as program and organizational goals.

The ideal candidate for this position will have prior experience in a healthcare setting and demonstrate flexibility and responsiveness in a health care enrollment environment that is consistently changing.

 

WHAT YOU'LL DO

  • Oversees and coordinates the daily operations and maintenance of the SFHP Service Center, including client and appointment management, front desk reception, and the coordination and triage of customer service functions.
  • Ensures accurate and efficient delivery of SFHP’s enrollment & eligibility services including application assistance and health coverage eligibility navigation for Medi-Cal, CalFresh, Medicare, Healthy Kids, Covered California and other health coverage programs.
  • Partners with San Francisco government agencies administering health coverage programs to align Service Center services to existing enrollment and eligibility practices.
  • Fosters and develops a high-performing team ensuring staff are adequately trained and certified according to their job responsibilities and requirements.
  • Identifies critical issues and trends, makes recommendations, and provides guidance and counsel to senior management on issues and concerns and status of initiatives.

 

WHAT YOU'LL BRING

  • A Bachelor’s degree or equivalent work experience. Master’s degree in health-related field preferred.
  • 5+ years of related work experience; minimum of 2 years of management experience in a health or social services program environment.
  • At least 2 years of experience managing and developing subordinates of diverse backgrounds, promoting teamwork and encouraging innovative ideas.
  • Bilingual capability in Spanish or Cantonese desired.
  • Successful completion of the Covered California certification and training within 90 days of hire.
  • Knowledge of the delivery of health care services in San Francisco, and publicly-funded health care programs in California is desired.
  • Ability to create a positive and healthy work environment for a team of employees with a range of experiences and cultural backgrounds.
  • Strong and effective verbal and written communication skills to multi-lingual and multi-level audiences, e.g., members, participants, providers, staff, management, community-based organizations and external agencies.
  • Exemplary interpersonal and customer service skills.  Consistently demonstrates professionalism, poise, tact, and diplomacy in interactions with community members and organizational representatives from different backgrounds and interests. 
  • Demonstrates good judgment, organization, and time management skills.
  • High proficiency in MS Office (Word, Excel, PowerPoint, Access, Outlook). Competency in Microsoft Visio and SharePoint preferred.

 
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.

 

PM17

 

Job ID
2017-1065
Category
Policy Development & Coverage Programs


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 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.


POSITION SUMMARY:

 

As a Bilingual Customer Service Representative, you’ll have one of the most important roles in our organization as the face of our Health Plan.

If you enjoy working in an exciting, talented & fun team environment where you’ll learn a wealth of knowledge and grow your client relation skills, this is your opportunity. You should naturally thrive on listening, talking with and helping others, be outgoing and committed to improving every member’s call experience and help address any questions and/or issues professionally and efficiently.

You’ll be responsible for serving SFHP clients, among them our Health Plan members, prospective members, providers, staff members and the public in general. You’ll help to provide Health Plan orientation, education, and assistance, including plan benefits, updates, programs, policies, complaints and procedures. Being well spoken, clear and patient with all interactions should accurately describe you.

 

WHAT YOU'LL DO

  • Responds to customer requests, questions, concerns, and complaints in a timely, respectful, caring and competent manner.
  • Answers telephone calls promptly and minimizes delays that may lead to abandoned calls.
  • Verifies member eligibility, coverage or exclusion of services.
  • Assists members in selecting or changing personal doctors or medical groups according to established guidelines.
  • Informs and educates customers on Plan policies, procedures and services.
  • Promotes the rights and responsibilities of Plan members.
  • Provides information, referrals and coordinates member services with community resources for covered and non-covered services.
  • Participates in activities that reach out to prospective members and to the communities that the Plan serves.
  • Keeps the Customer Service Supervisor and Manager informed of service problems, changes in our contact database, including members, providers, resources, etc.
  • Receives customer complaints and works with the Customer Service Supervisor and/or Manager to resolve concerns.
  • Provides information to members on preventive and primary care services.
  • Compiles and enters electronic data.
  • Completes all training programs and certifications as required.
  • Assists prospective members with applications for Medi-Cal, Healthy Families, Healthy Workers and other lines of business as needed and according to guidelines.
  • Provides coverage of all areas under the responsibility of Customer Service, including front desk and mail services.
  • Performs other duties as assigned.

WHAT YOU'LL BRING

  • Bilingual fluency/skill in English and Russian, Chinese, Vietnamese, or Spanish is required. 
  • At least 1-2 years of experience in customer service, call center, or similar.
  • Excellent written/oral communication skills with a high degree of professionalism, including discretion in working with confidential information.
  • Good knowledge of MS Office and customer management applications.
  • Ability to produce accurate, precise and quality work in a dynamic and diverse environment while meeting deadlines.
  • Able to work well both as a team and independently.
  • Familiar with health care and managed care terminology.
  • Prior experience in health care and knowledge of managed care or Medi-Cal preferred.
  • College degree is preferred or equivalent work experience.
  • Ability to work a part time schedule - 20 hours per week.

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.

Job ID
2017-1061
Category
Operations

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 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.

 

POSITION SUMMARY

 

As a Bilingual Customer Service Representative, you’ll have one of the most important roles in our organization as the face of our Health Plan.

If you enjoy working in an exciting, talented & fun team environment where you’ll learn a wealth of knowledge and grow your client relation skills, this is your opportunity.  You should naturally thrive on listening, talking with and helping others, be outgoing and committed to improving every member’s call experience and help address any questions and/or issues professionally and efficiently.

You’ll be responsible for serving SFHP clients, among them our Health Plan members, prospective members, providers, staff members and the public in general.  You’ll help to provide Health Plan orientation, education, and assistance, including plan benefits, updates, programs, policies, complaints and procedures.  Being well spoken, clear and patient with all interactions should accurately describe you.

This position is a temp-to-hire and bilingual fluency in English and Russian, Spanish, Vietnamese,  or Cantonese is required. Excellent benefits like very generous PTO, free health insurance, commuting subsidies and retirement benefits are provided after your temporary status ends and you become an SFHP employee.

 

WHAT YOU'LL DO

  • Responds to customer requests, questions, concerns, and complaints in a timely, respectful, caring and competent manner.
  • Answers telephone calls promptly and minimizes delays that may lead to abandoned calls.
  • Verifies member eligibility, coverage or exclusion of services.
  • Assists members in selecting or changing personal doctors or medical groups according to established guidelines.
  • Informs and educates customers on Plan policies, procedures and services.
  • Promotes the rights and responsibilities of Plan members.
  • Provides information, referrals and coordinates member services with community resources for covered and non-covered services.
  • Participates in activities that reach out to prospective members and to the communities that the Plan serves.
  • Keeps the Customer Service Supervisor and Manager informed of service problems, changes in our contact database, including members, providers, resources, etc.
  • Receives customer complaints and works with the Customer Service Supervisor and/or Manager to resolve concerns.
  • Provides information to members on preventive and primary care services.
  • Compiles and enters electronic data.
  • Completes all training programs and certifications as required.
  • Assists prospective members with applications for Medi-Cal, Healthy Families, Healthy Workers and other lines of business as needed and according to guidelines.
  • Provides coverage of all areas under the responsibility of Customer Service, including front desk and mail services.
  • Performs other duties as assigned.

WHAT YOU'LL BRING

  • Bilingual fluency/skill in English and Russian, Chinese, Vietnamese, or Spanish is required. 
  • At least 1-2 years of experience in customer service, call center, or similar.
  • Excellent written/oral communication skills with a high degree of professionalism, including discretion in working with confidential information.
  • Good knowledge of MS Office and customer management applications.
  • Ability to produce accurate, precise and quality work in a dynamic and diverse environment while meeting deadlines.
  • Able to work well both as a team and independently.
  • Familiar with health care and managed care terminology.
  • Prior experience in health care and knowledge of managed care or Medi-Cal preferred.
  • College degree is preferred or equivalent work experience.

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.

Job ID
2017-1058
Category
Operations