Provider Data Coordinator at San Francisco Health Plan in San Francisco, California

Job Description:

The Provider Relations department provides excellent customer service and regulatory guidance to provider organizations, keeping all participating providers happy and well-informed. The ideal candidate will work well in a fast-paced environment and develop a complete understanding of Medi-Cal and HMO health insurance in order to serve providers' needs quickly and confidently.

The Provider Data Coordinator is primarily responsible for maintaining the accuracy of San Francisco Health Plan (SFHP)'s provider data to ensure accurate directories, payment, and reporting. The Coordinator will be a user of our managed care system, QNXT, and must have excellent information systems skills. The Coordinator will synthesize provider information from many sources and partners throughout the Bay Area, and will be adding, modifying, and terminating providers (contracted and non-contracted, professionals and organizations) and ensuring we have complete context for each provider (license/qualifications, financial relationships, relation to other providers, etc) in the health plan's core system, QNXT.

The Provider Data Coordinator will be a part of the Provider Relations team and work closely with contracting and the Provider Network Operations Manager to evaluate the breadth and depth of the provider network, research providers to address weak points in coverage, and build rewarding relationships to ensure a strong network of medical caregivers.

The following qualities are critical for success:

• Commitment to the mission of San Francisco Health Plan, and service to low income residents of San Francisco.
• Commitment to our four organizational goals: universal coverage, high quality care and access to care, exemplary service, and financial viability for the plan and the safety net.
• Commitment to excellence, and going the extra mile for our members, providers and staff.
• Ability to excel as part of a team, with skills in respectful and collaborative communication.
• Exquisite attention to detail, and ability to perform extremely accurate data entry.
• Curiosity and willingness to problem-solve – not accepting things at face value without investigation.
• Ability to synthesize an end-to-end understanding of the managed care system, and to use this understanding to solve problems and optimize our provider directory processes.

SFHP proudly supports a hybrid work environment. This role will be required to be in-office, on-site a minimum of 4 days per month.

Salary range: $25.57/hr - $30.67/hr

WHAT YOU WILL DO

• Maintain source data for a Provider Directory that complies with all provisions of California law.
• Perform demographic data entry for new, modified and termed providers, ensuring accurate information.
• Conduct quality assurance review and analysis.
• Maintain metrics to measure the efficiency of the data entry process.
• Provide training on the QNXT provider module and the relevant load functions and vendor set up in QNXT.
• Provide support in developing processes to review and validate all provider data housed in QNXT provider module.
• Ensure that all data capture, transfer, and entry of practitioner data are in compliance with NCQA, Medi-Cal and other regulations.
• Provide support in maintaining other provider databases (e.g. provider portal, credentialing records).
• Foster an environment that solicits and enlists diverse and inclusive perspectives and approaches to better serve our staff, our members and our providers.

WHAT YOU WILL BRING

• Two years of college required, but AA or Bachelor's degree preferred
• Extraordinarily accurate data entry skills
• Proficiency with Excel, Word, Sharepoint, Outlook
• Familiarity with relational data warehouses, queries, SQL are a plus, but not required.
• Superior attention to detail and data entry skills.
• Demonstrated collaboration and problem solving skills.

WHAT WE OFFER

• Health Benefits
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development - Opportunities for tuition reimbursement, professional license/membership.

ABOUT SFHP

Established in 1997, San Francisco Health Plan (SFHP) is 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 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

#LI-Hybrid

PI250760920