Under limited supervision, provides support and leads activities ranging from routine to complex, requiring excellent judgment and decision-making abilities. Requires initiative to determine proper approach or action to take in non-routine situations. Position will grow to have extensive knowledge of State health care programs and requirements, as well as substantial development in the areas of health care compliance, regulations and new health care reform initiatives at the local, as well as statewide levels (e.g. Medi-Cal expansions and children's health programs).
This individual must be extremely professional, demonstrate high standards integrity, confidentiality, enjoy interacting with people at all levels, thrive in a fast-paced environment, and work with minimal supervision. Strong organizational skills, excellent oral and written communication skills, attention to detail and accuracy are essential as are the abilities to multi-task and to maintain strict confidentiality.
ESSENTIAL DUTIES & RESPONSIBILITIES
- Timely responses to State inquiries, including ad hoc inquiries, State Fair Hearings, Independent Medical Review requests and Consumer Complaints.
- Ensures activities of the Policy and Compliance Committee are current on Square One.
- Analyzes Compliance Program reports for trends and need for corrective action.
- Oversees and conducts internal audits as assigned.
- Coordinates audits by governmental agencies.
- Trains staff on aspects of new legislation, contracts, compliance, HIPAA and other regulations.
- Leads organizing, tracking and responding to subpoenas and liens for all SFHP lines of business.
- Leads implementation of business continuity plan.
- Serves as one of the department liaisons with state agencies.
- Drafts, coordinates and oversees portion of state filings.
- Analyzes and coordinates implementation of new regulations and legislation as assigned.
- Ensures smooth functioning of assigned area of responsibility.
- Coordinates activities between departments as relevant to the Compliance and Regulatory Affairs department.
- Appropriately refers substantive questions / key business issues to others and follows up to ensure resolution on behalf of the manager.
- Assesses problems and develops solutions following general policies and procedures.
- Performs special assignments for the manager, which requires researching and collecting information needed to complete projects or reports; locating, analyzing and summarizing data to identify variances and provide recommendations; and producing reports requiring specialized content knowledge, which may be the basis of significant decisions.
- Assists with department budget, including processing invoices and variance reports.
- Department team building event planning and other initiatives to enhance communication.
CORE COMPETENCIES / KNOWLEDGE & SKILL REQUIREMENTS
- Knowledge of health care compliance and HIPAA, required.
- Knowledge of State programs, required.
- Experience in coordinating and providing support to large complex projects.
- Excellent oral and written communication skills required.
- Excellent attention to detail and organizing abilities..
- Excellent logic, planning and problem-solving skills.
- Strong knowledge and application of English grammar including composition, editing and proofreading skills.
- Strong time management and project management skills and multi-tasking abilities.
- Advanced level proficiency with MS Office applications (Word, Excel, PowerPoint, Access) with expertise with word processing, spreadsheets, graphics and presentation software including the ability to create tables; merge documents; and develop graphics and PowerPoint presentations from notes.
- Familiar with a variety of general office concepts, practices and procedures.
EDUCATION, EXPERIENCE & TRAINING REQUIRED
- Bachelor's degree or equivalent work experience
- JD preferred
- Healthcare Compliance Certification preferred
- Five plus years of administrative assistant or specialist experience in a health plan environment preferred
- Strong working knowledge of State program regulations and HIPAA
WHO WE ARE
Established in 1997, San Francisco Health Plan (SFHP) is a 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 145,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.
San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.