AmeriHealth Caritas Manager Corporate Provider Network Operations in Philadelphia, Pennsylvania

Manager Corporate Provider Network Operations


Description

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

The Manager, Corporate Provider Network Operations is responsible for the accuracy and completeness of new business provider data for the purposes of initial data loads into Enterprise systems (FACETS, Contract Manager, etc.). The scope of this role is to support all new business for Medicare and Medicaid product lines.

Other accountabilities:

  • Act as the subject matter expert on data including but not limited to: individuals (physicians, alternative providers, etc.); Healthcare Institutions (Hospitals, Clinics, Systems, etc.), Ancillary Data (SNF, DME, LTSS, etc.)
  • Oversee the continued development, administration and maintenance of provider contracting implementation processes to submit Request For Proposal (RFP) for Medicaid and/or Medicare Programs.
  • Responsible for tracking the accuracy and completeness of provider data and information as the entry point for such data into Enterprise systems (FACETS, Contract Manager, etc.)
  • Manages the in-depth analysis of new and existing data elements and sources.
  • Primary source validation in support of data validation and issue resolution.
  • Collaborates with other business stakeholders to understand and translate the requirements for new products into data and database requirements.
  • Provide inter-departmental training on data and infrastructure topics.
  • Supervise the work of direct reports to align with established organizational policies, procedures, and practices. Set clear goals and objectives and uses metrics to measure performance and hold staff accountable. Provide coaching to improve performance and holds regular development discussions with direct reports.

Job Related Requirements: Qualifications Knowledge/Skills/Abilities:

  • Required 5-8 years of progressively advanced experience in a managed care environment with specific responsibility for provider data, network operations, ore related area.
  • Required Bachelor’s Degree or equivalent work experience
  • Required prior data management experience
  • Required working knowledge of health care provider data systems
  • Required training and demonstrated skill with proprietary or commercial provider data management software products
  • Required understanding of state and federal regulatory environment.
  • Required ability to work with and integrate data from multiple sources.
  • Required proven ability to coach and lead a team effort; proven ability to work independently with minimal oversight; ability to plan organize and handle multiple tasks independently and excellent oral, presentation and written communication skills.