Database Supervisor

Health Net, Inc. (NYSE: HNT) is among the nation's largest publicly traded managed health care companies. Health Net's mission is to help people be healthy, secure and comfortable. The company's POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company's Web site at www.healthnet.com



JOB SUMMARY:



The Database Supervisor coordinates and oversees the content and use of the credentialing database, and supervises the technical support staff in its maintenance and operation. Ensures that the organization's technical credentialing criteria comply with contractual, accrediting organization, state, and federal regulatory credentialing program standards for all providers. Recommends efficient and cost effective methods and practices for maintaining and reporting credentialing criteria. Prepares and analyzes reports and documents from department operational data, and identifies trends and patterns. Participates in establishing Credentialing Department operating goals and implements procedures and performance standards to achieve these goals.



ESSENTIAL DUTIES AND RESPONSIBILITIES: Supervises, monitors, and coordinates all credentialing database activities to ensure compliance with contractual, accrediting organization, state, and federal regulatory standards. Supervises the technical support staff in meeting the requirements of the credentialing program for all providers.Prepares, analyzes, monitors, and controls daily technical operations related to credentialing data and inventory of credentialing files, including scanning activities.Prepares database reports, documents and graphs for management.Recommends methods and practices for cost effective credentialing criteria to comply with regulatory and accrediting standards.Reconciles the credentialing database with the claims system after each credentialing committee meeting, which occurs monthly.Maintains the accuracy, currency and integrity of the credentialing database, assuring that the information is presented completely and appropriately to internal and external users and credentialing bodies. Ensures confidential information is protected.Performs data transfers with internal and external contracted organizations, including the Credentials Verification Organization (CVO) and Provider Data Management (PDM). Participates in the establishment of Credentialing Department operating goals, and implements procedures and performance standards to achieve these goals. Maintains ongoing internal and external communication with subordinates, providers, management, groups, regulatory bodies, and corporate.Develops template letters and forms to streamline information and for continuous process improvements.Identifies problems and data trends, and recommends appropriate follow up. Reviews and revises departmental policies and procedures, and desktop procedures as needed.Trains employees on departmental systems, processes, technical issues, changes and updates to the credentialing software. This includes Credentialing Department employees as well as users who are external to the department.Completes special projects, such as coordinating and assisting on internal projects and accreditation activities, and collaborating with other department supervisors under instruction of department director. REQUIREMENTS


REQUIREMENTS:



Education:

Formal training in electronic data bases and reporting; Bachelor's degree preferred.



Certification/License:



Experience:Three years experience working on relational electronic databases, preferably Microsoft Access, using SQL. Minimum two years supervisory experience.

Knowledge, Skills & Abilities:Knowledge of any combination of the following: TRICARE, NCQA, URAC, and JCAHO standards, or other regulatory reporting requirements that are similar in level of detail and data requirements. Knowledge of national medical credentialing standards, or those of another profession that are similar. Leadership or supervisory skills to oversee subordinates in accordance with company protocols and high ethical standards. Effective decision-making and problem solving skills. Proven ability to work independently, completing multiple tasks with competing priorities under heavy deadlines. Excellent organizational skills and attention to detail, along with the ability to plan and organize projects without compromising day-to-day workload. Skill to coordinate and maintain large, proprietary databases, and to code management and regulatory data reports using fourth generation programming language such as Crystal Reports. Knowledge of data elements, definitions and the skill to perform electronic data and image transfers. Master or expert level skills in Microsoft office products, including Word, Excel, and Access. Ability to evaluate and interpret written policies and procedures. Knowledge of provisions and protocols for maintaining the security of confidential data. Familiarity with medical terminology, preferably related to the credentialing program. Oral and written communication skills including the ability to compose correspondence, deliver presentations, give instructions and explain policies and decisions. Demonstrated professional conduct; excellence and professionalism portrayed consistently in all aspects of daily work attitude and performance.

OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.



As a government contractor, this position requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF85P or higher security.



Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.



Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.