Health Plan Program Manager, Medical Staff Office, UCSF
Posted on October 21st, 2015
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Program Manager - Medical Staff Office
Laurel Heights Location; San Francisco, CA
Job ID # 9952
Job Summary
This position is responsible for supervising and overseeing team productivity and quality/process improvement as it relates to Health Plan Enrollment. Ensuring that all billing providers at UCSF and affiliates are appropriately and accurately credentialed and enrolled into all commercially contracted health plans, Medicare, Medi-Cal and Tricare which is required to appropriately generate revenue in the course of patient care.
This position will supervise team productivity and work product quality by monitoring results, organizing improvement initiatives, managing improvement projects and gaining/sustaining business relationships. Initiates and cultivates partnerships with department management, medical staff /hospital/health plan/payor leadership and information technology teams to ensure compliance and optimal efficiency for appropriate membership, privileges and health plan enrollments for UCSF Medical Staff, Advanced Health Professionals and CVO contracted facilities (LPPH&C, School of Dentistry and others, as applicable). First responder to data integrity/system interface issues as well as performs auditing functions pursuant to UCSF policies and procedures, The Joint Commission and NCQA standards, commercial contracted agreements, as well as State and Federal laws and regulations including the Affordable Care Act. Continuous performance improvement team supervisor to achieve department and organization goals/workplans. Interprets and develops policy and procedures, manages training and orientations to a variety of constituents and supervises efforts to sustain best practices.
This position works directly with the Associate Director to develop and establish sustainable work flow processes related to Health Plan Enrollment. This position works directly with UCSF billing agents and contracted health plans to resolve billing issues on a daily basis.
Required Qualifications
-Bachelor’s degree or equivalent combination of education and experience; graduate degree can be substituted for experience
-Minimum of 5-7 years of work experience in healthcare environment with specific emphasis in provider enrollment, managed care, health plans affairs at an academic medical center and/or medical staff operations
-CPC or CPCS/CPMSM certification (or obtained within 18 months of hire)
-Knowledge of the regulations (TJC, CMS, CDHS, NCQA, HCFA etc.) regarding the operations of a Provider Enrollment operation, and/or Medical Staff Services Office, and/or a -Credentialing Verification Office. Able to review and understand local, state, and federal regulations
-Previous experience working in a work environment that requires a high-level of confidentiality and sensitivity, and an understanding of the regulatory requirements for maintaining this confidentiality
-Ability to maintain confidentiality and use discretion when handling sensitive medical staff issues
-Ability to organize, prioritize, and monitor assignments and workload
-Possess ability to set priorities and manage multiple demands effectively
-Ability to work with and lead credentialing staff with special performance improvement projects
-Excellent, proven writing skills and outstanding organization/planning skills to anticipate workload deadlines
-Proficiency with MS Office, Epic EMR system, HLS/ECHO, or other credentialing software
-Excellent communication, conflict-management skills, and customer-service skills
-Ability to interact with all levels of the Medical Staff, including Medical Staff leaders, Department Chairs, Division/Service Chiefs, and medical staff providers
-Ability to function well within a team and independently
-This position requires the flexibility to orient and work in all UCSF Medical Center location
Preferred Qualifications
-Master’s Degree in Business Administration, Public Health, Public Administration
-Previous experience with Medical Staff credentialing or medical staff/governance committees and/or working with highly confidential/sensitive materials
We offer a comprehensive benefits package effective on the first day of employment and a location in the heart of San Francisco.
Apply online at
http://jobs.ucsfmedicalcenter.org/
for official consideration and search using the
Job Opening ID 9952.
For more information, please contact
Cynthia Nessel at
EOE
UCSF Medical Center
UCSF Benioff Children’s Hospital San Francisco