Provider Network Development Coordinator
San Francisco Health Plan - San Francisco, CA

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POSITION TITLE: Provider Network Development Coordinator

DEPARTMENT: Operations

FLSA STATUS: 6-month limited term position

REPORTS TO: Director, Provider Network Development

SUPERVISES: N/A

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:

Universal coverage

Quality care and access

Exemplary Service

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

SIGNIFICANT CONTACTS

Internal:
Director, Provider Network Development

Contract Specialist

Provider Relations Data Coordinator

Provider Relations staff

Contracts staff

All other SFHP internal employees, especially Contracts and Operations

External (if applicable):
Ancillary providers

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.

WORKING CONDITIONS

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 - save job - block
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