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AmeriHealth Caritas Manager Network Operations in Baton Rouge, Louisiana

Manager Network Operations

Location: Baton Rouge, LA

Telecommuter?: No

ID**: 18258

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:

  • Manages the day-to-day activities of the Network Operations department and staff.

  • Supervises, directs, monitors, reviews and coaches all Network Operations staff members and their work performance.

  • Assists with activities related to provider satisfaction, communication and compliance.

  • Ensures department and staff remain current in all aspects of Federal and State rules, regulations policies and procedures

  • Ensures that the department staff Medicaid and coding knowledge is up to date by remaining current with proposed changes coding changes

  • Creates or modifies departmental policies to reflect changes.

  • Responsible for the accuracy of provider claims and leading the department in major upgrades resulting from regulatory and corporate directives.

  • Identifies root cause analysis and resolution for claim issues and system configuration while maintaining accurate claims payment and provider satisfaction

  • Ensures the department meets annual goals and objectives.

  • Acquires knowledge and skills to maneuver around Facets program

  • Performs other related duties and projects as assigned

Education/Experience:

  • Bachelor’s Degree.

  • 5-10 years Managed Care experience.

EOE Minorities/Females/Protected Veterans/Disabled

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