POSITION TITLE: Provider Network Development Coordinator
FLSA STATUS: 6-month limited term position
REPORTS TO: Director, Provider Network Development
EVALUATION DATE: 11/2012
This is a six-month limited term position.
Under the direction of the Director, this position is responsible for conducting specific functions aligned with SFHP’s goals of:
Quality care and access
Financial viability for the plan and safety net
The Provider Network Development Coordinator will support the functions related to management of the SFHP provider module in the managed care system (MCS). Primary function of this position will be adding of providers to, and changing provider information in the MCS. Additionally, he/she will conduct initial and ongoing credentialing of ancillary providers, and support the Contract Specialist with completion of Liens and Subpoenas.
This position is a 6-month limited term position, and works closely with clinical and non-clinical staffs both internally at SFHP, and externally with ancillary providers. This is a good opportunity for someone looking to learn more about managed care health plan operations and contracting requirements. Ability to collaborate with internal and external stakeholders, and to manage small projects from beginning to end, is required.
ESSENTIAL DUTIES & RESPONSIBILITIES
Complete adds and changes to the managed care system provider module as needed
Support the ongoing maintenance of providers in the MCS
Conduct the initial and annual credentialing of ancillary providers
Assist with the completion of tasks related to Liens and Subpoenas
Provide additional support to the Provider Relations, and Contracting departments with day-to-day operations
CORE COMPETENCIES / KNOWLEDGE & SKILL REQUIREMENTS
Ability to communicate effectively (spoken and written), with a variety of professionals, including physicians and other health providers, administrators, and others
Detail-oriented and organized with the ability to interpret policy and make decisions
Versatility, flexibility, and professionalism
Strong time management skills are required for managing multiple priorities
EDUCATION, EXPERIENCE & TRAINING REQUIRED
Bachelor’s degree preferred
Prior experience in a managed care setting, provider organization or with health policy is a plus
Ability to work with multiple departments within the organization and external clients
Experience with QNXT or other managed care systems is a plus
COMMUNICATION & INTERPERSONAL SKILLS
Candidate must be a polished professional.
Excellent interpersonal skills both written and verbal.
Ability to explain complex problems and/or solutions in language appropriate for the audience
Meticulous attention to detail.
Must be knowledgeable and proficient in numerous computer software programs including Microsoft Suite (Word, Excel, Outlook, PowerPoint, Access), Sharepoint, Visio, etc
Familiar with a variety of general office concepts, practices and procedures
Ability to work well with all levels of internal management and staff, as well as outside clients and vendors
Ability to use diplomacy, discretion and maintain confidentiality of sensitive matters a must.
Superior planning and organizational skills required.
Exceptional grammatical, spelling proofreading English skills.
An assertive team-player with excellent customer service skills
Director, Provider Network Development
Provider Relations Data Coordinator
Provider Relations staff
All other SFHP internal employees, especially Contracts and Operations
External (if applicable):
Out-of-network provider offices
ESSENTIAL FUNCTIONS—PHYSICAL POSITION REQUIREMENTS; MACHINES AND/OR EQUIPMENT USED
PC literacy required; MSOffice skills (Outlook, Word, Excel, PowerPoint)
Regularly required to operate standard office equipment
Ability to work on a computer up to 8 hours a day
Regularly required to sit for long periods of time
Regularly required to use hands to operate office equipment
Close vision required for computer usage
Occasionally required to stoop, kneel, climb and lift up to 25 pounds.
Standard office environment without unpleasant or hazardous conditions. Work entails typical physical demands involved in office work. May require occasional weekend and/or evening work.
NOTE: This description is not intended to be construed as an exhaustive list of duties, responsibilities or requirements for the position. This position may change or assume additional duties at any time. The employee may be requested to perform different or additional duties as assigned.
San Francisco Health Plan - 19 months ago