Supervisor Provider Network Operations - Baton Rouge, Louisiana

AmeriHealth Caritas; Baton Rouge (LA); Hybrid; USD 45,000 - 75,000; Full time

Job summary

Join a mission-driven organization that is dedicated to improving healthcare outcomes. As part of a dynamic team, you will play a crucial role in enhancing the efficiency of the Provider Network Operations department. This position offers the opportunity to lead and support initiatives that directly impact the quality of care provided to our members. With a commitment to diversity and inclusion, you will thrive in an environment that values your contributions and encourages professional growth. If you're passionate about making a difference in healthcare and want to be part of a collaborative team, this is the perfect opportunity for you.

Benefits

Flexible Work Solutions

Health Insurance Coverage

401(k) Tuition Reimbursement

Paid Time Off

Holidays and Volunteer Events

Qualifications

• 1-3 years of experience in managed care or healthcare settings.
• Management experience required, knowledge of Medicaid preferred.

Responsibilities

• Assist manager with departmental initiatives and process changes.
• Supervise provider inquiries and ensure timely resolutions.
• Monitor operational compliance and recommend solutions.

Skills

Managed Care

Medicaid Claims Coding

Provider Data Management

Issue Resolution

Education

Associate Degree

Equivalent Work Experience

Job description

Your career starts now. We’re looking for the next generation of healthcare 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 healthcare 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 Newtown Square, 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.

About this job:

This position is responsible for participating in the day-to-day activities of the Provider Network Operations department and supervising, directing, monitoring, reviewing, and coaching staff and their work performance.

Responsibilities:

1. Responsible for assisting the manager with implementing new departmental initiatives and process changes to ensure department efficiency and compliance with contractual and internal requirements and Service Level Agreements.
2. Supervises the research of informal provider inquiries and complaints to ensure all are resolved in a timely manner and minimize disruption of the Plan’s network.
3. Provide management with issue feedback.
4. Oversees and monitors provider data maintenance and claims activities to provide feedback and recommendations.
5. Monitors operational compliance with Plan policies and procedures and recommends solutions to management when problems occur.
6. Performs other related duties and projects as assigned.

Education & Qualifications:

1. An associate degree or equivalent combination of education and work experience is required.
2. 1 to 3 years of experience in managed care or related healthcare settings, including Medicaid claims coding, payment, and provider data.
3. 1 to 3 years of management experience required.
4. Knowledge of Medicaid reimbursement and methodologies is preferred.
5. Candidate must reside in Louisiana.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.