San Francisco Health Plan

 

Our CEO - Mission and Vision      

             



Our mission remains our focus. We provide health care to over 145,000 members. With Healthy San Francisco, we offer health care services to over 160,000 residents, or over 19% of the City’s population, which is one in six San Francisco residents. We are an award winning health care organization created by, and for, the residents of San Francisco. There has never been a more exciting time to join SFHP as we continue to improve our award winning model for healthcare reform.

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Do you love digging into the "X's and O's" of healthcare claims systems and driving efficiency through collaboration and system improvements?     In this role as a Configuration Analyst, you'll be responsible for application configuration and leverage your project planning, execution, and implementation acumen to drive changes to our mission-critical business applications and analyze application configuration to ensure it is efficient in setup and functionality.   WHAT YOU WILL DO - Implement and configure the QNXT health claims system by prototyping, analyzing, implementing and documenting the process changes. - Partner and collaborate with a Senior or Lead Business Solutions Analyst to resolve complex changes. - Partner with our testing team and key stakeholders to develop and execute appropriate test plans and ensure the configuration changes work as was intended. - Develop and recommend operational processes improvements. - Document functional specifications for system solutions and enhancements to existing business systems. - Communicate results through written documents and maintain configuration database. WHAT YOU WILL BRING - A Bachelor’s degree (e. g., BS), or equivalent work experience. - Experience working at a healthcare organization. - 3-5 years of experience as a Business Systems Analyst and/or Configuration Analyst - QNXT configuration and testing experience (i.e., prototyping, enhancements, unit testing and system upgrades). - Functional understanding of health care claims processing and data sets (i.e., ICD-9/10 and CPT/HCPCs, provider contracts and benefits). - Excellent communication skills with demonstrated ability to effectively exchange information with business and technical audiences at all levels. - Ability to be effective individually or working with a team.    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 130,000+ 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
2020-1709
Category
Operations
As the Contract Manager you'll work collaboratively with the rest of the Contracts and Provider Relations teams and assist with the negotiation and implementation of SFHP’s primary network clinic, medical group, hospital, and ancillary provider contracts. You will work collaboratively with both external providers of health care services and internally as necessary to establish new long-term agreements. You may also be called upon to resolve contract related issues that arise between any manner of internal or external customers.   WHAT YOU’LL DO - Develop and manage provider contracting efforts and partnerships. - Lead the development of contracting strategies based on new or existing initiatives and requirements. - Ensure all configuration changes pertaining to new or amended contracts are implemented in a timely and accurate manner. - Successfully negotiate the terms and conditions of contracts and other transaction documents, finding creative solutions to avoid and resolve potential contractual impasses. - Monitor ad-hoc out-of-network service agreements to determine provider contract opportunities. - Communicate new and updated contract terms and rates to internal stakeholders. - Lead the contract templates and amendments development process. - Maintain effective working relationships with SFHP providers, vendors and medical groups, and internal staff. - Provide guidance and training to internal partners on contracting efforts, needs, and process. - Assists with assignment and monitoring of department staff. WHAT YOU’LL BRING - Experience in managed care contracting. - BA/BS in Business, Health Care or related field with two years of work experience or Masters Degree in Business, Health Care Administration or related field with one year of experience is required - Knowledge of managed care and Medi-Cal and other entitlement programs is strongly preferred. - Knowledge of claims system configuration practices is preferred. - Ability to communicate effectively (spoken and written), give presentations and lead diverse groups. - Project management experience is preferred - Detail orientation and organization skills with the ability to interpret policy and make recommendations. - Knowledge of Microsoft Access and Visio is preferred as well as background in data analysis. - Strong experience with MS Office (Outlook, Word, Excel, PowerPoint, Sharepoint, Access) 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 132,000+ 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
2020-1673
Category
Operations