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Provider Data Specialist

San Francisco Health Plan

San Francisco Health Plan

San Francisco, CA, USA
Posted on Friday, May 3, 2024

Under direction of the Senior Manager, Provider Relations, the Provider Data Specialist is responsible for ensuring the integrity and accuracy of San Francisco Health Plan (SFHP)’s provider data while working collaboratively with all internal and external stakeholders in an effort to meet and/or exceed all regulatory and industry provider data quality and accuracy standards. You will be a skilled user of the managed care system (QNXT) and have excellent information systems skills.

Please note that while SFHP supports a hybrid work environment, this role will be required to be onsite and in-office a minimum of 4 days per month.

Salary: $37.00 - $42.30/hour


  • Extract and report data for various reports and analysis
  • Identify and initiate system improvements
  • Conduct audits to reduce errors and improve processes and performance
  • Reconcile additions, changes, and termination notices from providers with SFHP’s core provider database
  • Ensure the maintenance of current provider data
  • Coordinate corrective activities to improve data and user experience
  • Serve as representative on projects related to provider data management
  • Foster an environment that solicits and enlists diverse and inclusive perspectives and approaches to better serve our staff, our members and our providers


  • BA/BS in Business Administration, Health Care Administration, or related field preferred.
  • A minimum of two years combined experience in provider credentialing, provider directory, and/or provider relations.
  • Experience with writing audit reports, presenting information to and leading diverse groups.
  • Demonstrated working ability using a total managed care system.
  • Detail-oriented and organized with an understanding of provider information systems management.
  • Knowledge of industry standard provider credentialing processes and software systems.
  • Knowledge of regulatory requirements and regulations (DHCS, DMHC, NCQA, etc.) related to provider credentialing.
  • Strong computer and Web aptitude, solid understanding of how to use common platforms and applications.
  • The ability to collaborate effectively cross-functionally.


A competitive and robust compensation package, including:

  • Health benefits
    • Medical: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the HMO plans is currently available at no cost and dependent coverage is heavily subsidized by SFHP.
    • Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
    • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
  • Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan
  • Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays
  • Professional development: Opportunities for tuition reimbursement, professional license/membership.
  • An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare!
  • The chance to make a difference in the lives of many San Francisco residents!

Candidates will be required to show proof of Up-To-Date Vaccination against COVID-19 as defined by the San Francisco Department of Public Health upon beginning employment. Reasonable accommodations will be considered on a case-by-case basis for exemptions to this requirement subject to the applicable law[s].


Established in 1997, San Francisco Health Plan (SFHP) is 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 155,000+ 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 proud to be an equal opportunity employer. We are committed to a work environment that supports and respects all individuals and in which our processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.