Provider Data Jobs (NOW HIRING)

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At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

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Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Under the leadership of the Manager of Managed Care Applications, the Epic Tapestry, Supervisor Provider Management and Contracts Applications plays a key leadership role in overseeing the support and optimization of our organization's provider data and our organization's insurance health plan contracts, and compliance through the Epic Systems Tapestry application. You will lead a team of application analysts, ensuring the accuracy and efficiency of our provider data management processes, and that our contracts are effectively managed, and we maintain strong relationships with payors. Responsibilities includes:

Provider Management

• Collaborate with various operational departments to understand the organization's provider data management needs.

• Use the Tapestry application to maintain and update provider data, ensuring accuracy and completeness.

• Monitor data quality, address discrepancies, and ensure compliance with industry standards and regulations.

• Act as the primary point of contact for users of the Tapestry application in relation to provider data management.

• Analyze provider data management workflows and processes to identify opportunities for improvement and data accuracy.

Contracts

• Oversee utilization of the Tapestry application to configure, store, and track all insurance health plan contracts, ensuring proper documentation and compliance.

• Ensure that all contracts are maintained, up to date, and in compliance with regulatory requirements.

• Lead the management and maintenance of data related to insurance health plan contracts, including fee schedules, reimbursement rates, and service coverage.

• Conduct in-depth data analysis and validation to ensure data accuracy, consistency, and completeness.

• Provide strategic insights and recommendations to inform contract negotiations, financial planning, and decision-making.

Additionally, provide expert-level technical support, troubleshoot application-related issues, and lead the resolution of complex problems. Collaborate with operational users to implement system updates and enhancements. Works closely with Managed Care Manager on planning and executing strategic objectives and project initiatives. Recommend and lead the implementation of workflow optimizations to enhance efficiency and data accuracy. Create and maintain user-friendly documentation, guides, and best practices for application usage.

To the People they support

• Ensures that employees understand the purpose and vision of the organization and the team's connection to purpose.

• Works to ensure that employees are engaged and productive.

• Performs annual performance evaluations ensuring that employees are aware of challenges before review.

• Encourages participation in employee surveys and action plans.

• Monitor and measures employee workloads helping with prioritization and escalation as needed.

• Coaches team members on career development and individual development plans.

• Facilitates team daily or weekly team standup to discuss activities and determine barriers.

• Team champion.

To the Product(s) they support

• Monitors and measures supported system performance.

• Identify system challenges and works with the team to reduce errors and improve efficiency.

• Fully support and use the PRISM Change Management process.

• Ensure all incidents and problems are entered into PRISM.

To the Leadership / Business they support

• Supports the I.T. and Business Leadership in organizational goals.

• Ensures teams adherence to service level agreements.

• Ensures teams compliance with PRISM Service Management Standards.

Required Experience and Professional Skills

Experience

• Minimum 5+ years of experience as an individual contributor in the functional areas that they will be supporting.

• 5+ years of experience in healthcare data management and or payor contracts, with a minimum of 2 years in a supervisory or leadership position.

Professional Skills

• Demonstrated successful operational and people leadership capabilities.

• Proficiency with the Epic Systems Tapestry application is required.

• Knowledge of healthcare regulations and compliance, including HIPAA, is preferred.

Required Education and Certifications

• Master's/Bachelor's degree in a related field (Healthcare Administration, Information Systems, etc.) or equivalent experience.

• Epic Certification in Claims & Contract Admin and/or Referrals & Authorizations required.

Additional Information:

Salary: $123,000 - $162,000 Annual

Location: San Ramon or Sacramento (Remote Considered)

Hill Physicians is an Equal Opportunity Employer