Hours :
Shift Start Time: 8 AM
Shift End Time: 5 PM
AWS Hours Requirement: 8/40 - 8 Hour Shift
Additional Shift Information:
Weekend Requirements: No Weekends
On-Call Required: No
Hourly Pay Range (Minimum - Midpoint - Maximum): $27.280 - $34.100 - $40.920
The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will depend on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.
What You Will Do
Under the direction of the Manager of Network Management and Application Optimization, this position performs key functions in support of data management and network management activities, including but not limited to, provider data collection, reporting and analysis. Works closely with internal and external teams to generate accurate files and extracts to generate provider directories, regulatory filings, surveys and network reports.
Required Qualifications
- Bachelor's Degree in healthcare related field.
- 2 Years experience in health care industry.
- 1 Year work or residency experience in a managed care organization or health plan.
- Advanced-level Excel experience along with proficiency in MS Office applications.
- Driver's License - CA Department of Motor Vehicles - REQUIRED
Other Qualification Requirements
- Utilizes reliable transportation and possesses adequate personal insurance coverage. Demonstrates clean driving record in accordance with requirements of the employer DMV pull notice program and Sharp HealthCare Driver Guidelines.
Essential Functions
- Network Management
Manages the process for ensuring accurate and up-to-date provider data is maintained in network applications. Coordinates the internal production of directory extracts and works with external directory vendor to ensure accurate production of quarterly provider directories and/or addendums for the commercial and Medicare lines of business. Creates detailed specifications and desktop procedures, as needed. Works closely with the Digital team to ensure provider and network information is accurate and up-to-date on Sharp Health Plan’s digital web properties. Possesses exceptional writing and presentation skills to produce professional, well-written (clear and concise) presentations, network reports and other written materials. Performs other network management duties as assigned. - Data Management
Assists with day-to-day operations of provider data exchanges, working closely with internal teams and external vendors to create provider data files and extracts for provider directories, surveys and network reports within specified timeframes. Assists with provider data collection, abstraction and analysis. Tests and validates provider data for accuracy and completeness prior to dissemination. Works closely with internal data teams to request and verify summary reporting on an as needed basis. Consistently stores project documentation on appropriate shared platforms and provides audit support for regulatory and accreditation surveys through creation, maintenance and appropriate storage of projects, business rules and business process documentation in a timely and compliant manner. Performs other data management duties as assigned. - Reporting
Coordinates production of network access and adequacy reports for internal and external stakeholders, working closely with internal data teams. Produces complete and accurate regulatory filings and reports as needed. Provides timely status reporting on projects and activities as assigned. Coordinates and produces departmental metrics and maintains a process for consistent, timely, and accurate reporting. Creates and maintains departmental and project dashboards, coordinating inputs from various internal teams. Supports the development and maintenance of provider scorecards as part of ongoing network monitoring.
Knowledge, Skills, and Abilities
- Knowledge of customer relationship management, provider management, customer survey, project management, and credentialing software applications.
- Knowledge of healthcare regulators such as the Department of Managed Healthcare, Covered California, Centers for Medicare and Medicaid, and National Committee for Quality Assurance.
- Is adept in a variety of software applications and tools such as MS Excel, databases, and customer relationship management (CRM) platforms, e.g., Salesforce.
- Excellent interpersonal skills, including the ability to communicate clearly and concisely in a professional manner, both verbally and in writing.
- Strong organizational, critical thinking and analytical abilities in performance of all job duties.
- Ability to develop accurate, well-written and professionally formatted presentations, reports and other materials for internal and external consumption. Detail-oriented and able to function under pressure and perform multiple tasks efficiently.
- Ability to work independently as well as in a team environment.
Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class.
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