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Partnership HealthPlan of California · 7 hours ago

Provider Systems Manager

Fairfield, CA

Contract

Onsite

Entry, Mid Level

$103K/yr - $134K/yr

2+ years exp

Partnership HealthPlan of California is seeking a Provider Systems Manager to oversee daily operations of Provider Relations Systems and Data functions. The role involves ensuring the accuracy and timeliness of provider data, leading the PR Systems and Data staff, and monitoring compliance with quality measures.

Health CareInsuranceNon Profit

Culture & Values

Responsibilities

Manage the daily functions of the Systems and Data staff and monitor use of Partnership systems, including but not limited to the Amisys, and SUGAR systems. Provide leadership, direction, training, support, and daily supervision to staff

Monitor staff productivity, accuracy, and service delivery using performance standards

Provide monthly performance feedback to staff

Monitor inventory control reports weekly and adjust staff priorities based on inventory

Provide Director with bi-weekly inventory and aging reports and plan for improving timeliness when applicable

Conduct weekly staff meetings

Support staff development by identifying and overseeing staff training on new duties

Responsible for cross training; ensuring at least two staff can perform each function

Monitor compliance of the PR dept. quality measures; report monthly and quarterly

Develop and revise department policies and procedures

Interview and participate in selection of PR staff that are direct reports

Participate in preparation and interview process for Partnership audits; internal and external

Act as liaison with internal Partnership departments

Promote a positive attitude, team work, and fun in the workplace

Prepare documentation and participate in special projects

Ensure accuracy of regulatory reports and deadlines are met

Monitor and ensure accuracy of reports for HEDIS, DHCS, and DMHC

Department lead for Partnership system workgroups

Track and ensure accuracy of provider data and contracts in Partnership SUGAR database

Coordinate activities related to Partnership systems with Claims Configuration, IT, and Finance departments

Qualification

AmisysProvider data managementManaged care experienceBusiness software applicationsJudgmentCommunication skillsOrganization skillsDecision making

Required

Bachelor's degree in related field

Minimum two (2) years' experience in a managed care environment in provider relations/data, claims or IT

Knowledge of Amisys or similar managed care processing system

Understanding of provider data, provider payments and how changes impact systems and outcomes

Working knowledge of business software applications

Knowledge of managed care concepts, policies and procedures

Must have access to own reliable vehicle

Valid California driver's license and proof of current automobile insurance compliant with Partnership policy

Excellent oral and written communication skills

Excellent organization skills with the ability to prioritize assignments, maintain accurate records, and meet deadlines

Ability to use good judgment in making decisions within scope of authority and to handle sensitive issues with tact and diplomacy

Ability to use a computer keyboard

Ability to move, carry, or lift objects of varying size, weighing up to 35 pounds

Preferred

Experience in a managed care environment in provider relations/data, claims or IT

Experience with provider networks, including consolidations and setting up contracts in systems

Company

Partnership HealthPlan of California

Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

Founded in 1994

Fairfield, California, USA

1001-5000 employees