Sutter Health Provider Network Supervisor - Sutter Health Plus in Sacramento, California
The Provider Network Supervisor is responsible for overseeing the daily operation of provider network information for Sutter Health Plus. Activities include making strategic recommendations for network composition; creating and maintaining a provider database to enable accurate claims processing and provider directories; designing, overseeing and performing analytical projects to support operations initiatives and assisting with network, operations and care management business project initiatives to further the advancement of strategic goals set forth by Sutter Health Plus. This position is responsible for managing certain interactions between providers, the health plan, medical groups, risk bearing organizations and other Sutter Health System provider data resources in the support of Commercial and Medicare lines of business.
High school diploma/GED required. BA/BS degree or equivalent combination of education/experience desired.
• Must have 5 years in a managed care or health insurance environment with progressive and relevant operations experience.
• Must have 5 years in an provider network data support role
• Prior lead or supervisory experience desirable.
• Experience interacting with health care providers and familiarity with health care billing and payment practices.
• Ability to lead, communicate and interact with all levels of the organization, including senior management, to provide recommendations and influence decision-making.
• Experience in managing multiple, simultaneous, complex programs.
• Knowledge of health care contracting language, requirements and methods to support the development and maintenance of contract compliance, contract language review and analysis.
• Must possess some familiarity and understanding of DMHC regulations, various health care reimbursement models, pricing mechanisms, managed care and payer relationships.
• Must have knowledge of database management and data accuracy verification techniques.
• Required skills include ability to build collaborative working relationships with diverse individuals and organizations.
• Strong analytical and problem solving skills.
• Ability to operate independently, confidentially, and to garner confidence from SHP leadership, Sutter affiliates and Sutter Physician Services staff.
• Ability to work within and promote team environment concepts; exceptional interpersonal skills including oral and written communications in a wide variety of circumstances.
• Proficient in using Microsoft Word, Excel, Visio and PowerPoint, and internet research.
• Must demonstrate knowledge of HIPAA, Health Care Reform, Business Code of Ethics and government regulated programs.
Organization: *Sutter Health Plan
Title: Provider Network Supervisor - Sutter Health Plus
Location: California-Greater Sacramento Area-Sacramento
Requisition ID: SHP-1806074
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.