Supervisor Provider Network Operations

Work Arrangement

This is a remote position supporting the North Carolina market. Strong preference for a North Carolina resident.

Role Overview

This position is responsible for participating in the day-to-day activities of the AmeriHealth Caritas North Carolina Provider Network Operations department and supervises, directs, monitors, reviews, and coaches staff and their work performance. Supervises a team performing technical reporting, system operations, data analysis, and provider operational support functions. Oversees system audits, configuration validation, reporting accuracy, and data integrity activities to ensure operational compliance and performance. Provides technical leadership and guidance for complex operational issues, system enhancements, root cause analysis, and audit-related activities. Responsible for assisting the Manager with the implementation of new departmental initiatives and process changes. Assists with the implementation of process changes to ensure department efficiency and compliance with contractual and internal requirements and Service Level Agreements. Researches and supervises the research of informal provider inquiries and complaints to be sure all are resolved in a timely manner to ensure minimal disruption of the Plan’s network and provides management with issue feedback. Oversees and monitors provider data maintenance and/or claims activities and provides feedback and recommendations. Monitors operational compliance with Plan policies and procedures and recommends solutions to management when problems occur.

Education And Experience

• Associate Degree or equivalent combination of education and work experience required
• Business experience in managed care or related healthcare setting to include claims coding/payment and/or provider data preferred
• Minimum of 1 year of supervisory/ management/ leadership experience preferred

Knowledge

• Knowledge of Medicaid reimbursement and methodologies preferred
• Knowledge of provider data maintenance

Skills

• This is not an IT/IS Network position
• We need a Provider Relations Operations Supervisor that knows managed care and has Medicaid Claims experience

Benefits

• Comprehensive Benefits Package
• Flexible work solutions including remote options, hybrid work schedules
• Competitive pay
• Paid time off including holidays and volunteer events
• Health insurance coverage for you and your dependents on Day 1
• 401(k)
• Tuition reimbursement and more

Application Information

• For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required.
• Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

About the Company

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.