AmeriHealth Caritas Director Provider Network Operations in Manchester, New Hampshire

Director Provider Network Operations

Location: Manchester, NH

Telecommuter?: No

ID**: 16232

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 .

This position is contingent on a contract award

The primary responsibilities of this position include but are not limited to:

  • Provides oversight of the claims processing process to ensure the accuracy, timeliness and completeness of processing payment and reporting.

  • Responsible for the accuracy and completeness of provider data and information as the entry point for such data into Enterprise systems.

  • Responsible for provider and claims education including all provider materials to include, but not limited to provider handbook, provider website, provider newsletter and the, provider directory.

  • Responsible for quality oversight for all operations and administrative functions; serves as the Chairman of the Quality of Service Committee; initiates and oversees corrective actions plans for those services not in compliance with state contract.

  • Oversees the company’s desktop support services and staffing to assure that all local associates have access to appropriate hardware and connectivity for all plan systems.

  • Responsible for design, development and implementation of processes to assure compliance with the Plan contract.

  • Responsible for the analysis of provider reimbursement and updating codes and fee schedules for correct reimbursement to providers.

  • Assists in the establishment and achievement of business objectives for the area of responsibility based upon company’s overall strategic plan and operating goals

Education and Experience:

  • Bachelors Degree in Business or health related discipline such as Healthcare Administration or Healthcare Management or equivalent business experience, Masters Preferred

  • Minimum 5 years management experience, in a managed care setting, managing teams and projects.

  • Working knowledge and strategic understanding of medical billing principles, procedures, ICD-9, ICD-10 and/or CPT medical billing codes and documentation.

  • HIPAA, NCQA and Facets experience preferred

EOE Minorities/Females/Protected Veterans/Disabled