AmeriHealth Caritas Supervisor, Provider Disputes in Charleston, South Carolina

Supervisor, Provider Disputes

Location: Charleston, SC

Telecommuter?: No

ID**: 14178

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 atwww.amerihealthcaritas.com.

Responsibilities:

Supervise and assist in the day-to-day coordination and direction of the work of the Provider Disputes staff. Ensure the volume of work produced meets departmental and contractual expectations. Research more complex provider dispute issues and assists with resolutions. Ensure procedures are being adhered to and manage team progress to attain personal, departmental and corporate goals. Develop and implement recommendations for improving workflow/processes. Responsible for the gathering and production of complex statistical data analysis to identify common factors for provider disputes.

  • Works collaboratively with the Manager - Provider Network Operations to prepare reports and conduct analysis of operations/services as required by departmental, corporate and/or regulatory requirements.

  • Fosters relationships with subject matter experts in key stakeholder departments responsible for dispute resolution and monitors progress to insure prompt and professional handling of all provider disputes.

  • Delegate tasks appropriately to staff..

  • Collaborates with other departments to resolve issues in a timely manner per contractual requirements.

  • Utilizes system applications including Facets, Excel, Access, Crystal Reports and Business Objectives for obtaining and manipulating data for reporting, summarizing information as needed for all issues relating to provider disputes such as: claims processing, including COB, TPL, subrogation and cost containment issues.

  • Acts as the resource to other departments by developing and managing work plans which document the status of key relationship issues and action items for high profile providers.

  • Ability to respond to changing priorities, handle multiple tasks simultaneously and readily adapt to change.

  • Participates with Corporate Operations Team to provide research and resolution to issues.

  • Creates and supports an environment which fosters teamwork, cooperation, respect and diversity.

  • Oversees and is responsible for quality assurance activities related to provider dispute documentation and resolution. Also responsible for quality assurance as it relates to scheduled and adhoc statutory reporting.

  • Other duties as assigned by management.

Education/Experience:

  • Bachelor’s Degree or equivalent combination of education and experience with emphasis in health services administration, information systems, medical office administration and/or claims administration, Medicaid and Medical billing, payment and reimbursement.

  • Certified Professional Coder (CPC/CPT/HCPC ) preferred.

  • 3-5 years' healthcare environment operational experience including claims, configuration, claims analysis, provider contracting or any appropriate combination of these required.

  • Experience and demonstrated mastery of relational databases, reporting, development and analysis, using Microsoft Access or similar system, at a level relevant to and appropriate to carrying out Provider Network Analyst responsibilities required.

  • Formal training or equivalent experience in the effective use of reporting and querying software such as MS Excel, MS Access, BI Query, Crystal Reports and/or SQL required.

  • Claims processing and provider data maintenance knowledge required.

  • Understanding of and experience related to healthcare claims payment configuration process/systems and its relevance/impact on network operations required. This would include experience with Facets or similar applications and their supporting database schema and structure.

EOE Minorities/Females/Protected Veterans/Disabled