Your career starts now. We are looking for the next generation of health care leaders.
At AmeriHealth Caritas, we are 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 would like to connect with 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.
Reporting to the Senior Vice President, Enterprise Operations, the Vice President, Claim Payment Administration is accountable for partnering with organizational leadership to provide direction for application programming of the enterprise claims and provider platform, process improvement through robotic automation and preventing, detecting, investigating, and reporting fraud, waste and abuse (FWA).
This role will be responsible for overseeing teams who provide enterprise support in the areas of Robotic Processing Automation, Facets Configuration and Payment Integrity. The role will utilize leadership skills, as well as functional knowledge and expertise to drive improvement through analytics, process redesign, process automation, scalability, cross functional collaboration and change management.
- Responsible for the leadership and strategic direction of Configuration, RPA and Payment Integrity.
- Maintains a working knowledge of all company managed care activities: Provider Contracting, Member Services, Utilization Management, Claims, Capitation, Enrollment Provider Relations, Finance, etc., to provide RPA, payment integrity and Facets Configuration solutions for the enterprise.
- Conduct regular analysis of existing programs, processes, payment policies edits, vendors, internal controls, interdependencies and processes to identify opportunities for efficiency, increased claim payment accuracy, and automation across Enterprise Operations.
- Ability to develop an in-depth understanding of how organizational capabilities interrelate across the enterprise.
- Provide strategic direction for RPA and Payment Integrity vendor deployment, management and oversight activities including leading external contract negotiations, audits and provider meetings.
- Evaluate strategic risks of business alternatives, develop strategies, and select solutions to remedy or improve outcomes.
- Ensure the readiness of the technical environment for deployment, manage system configurations, evaluate deployment risk and execute corresponding mitigations.
- Provide strategic direction and oversee cross functional coordination to implement vendors, processes, system updates and controls to ensure the accurate, complete, and truthful claim payment in accordance with all relevant State and/or federal requirements.
- Ensure adherence to the production schedule, monitor system performance, respond to escalated user issues, conduct problem isolation, and implement solutions for existing products, segments as well as new business.
- Participate in the reengineering of business processes to help others achieve efficiency, and document business requirements while ensuring policy compliance of a robotic specification.
- Apply knowledge and experience to leverage a variety of technical solutions to address business problems.
- Influence others to take up change and work collaboratively on shared goals.
- Maintains up-to-date knowledge of emerging RPA technologies and industry trends to sustain leading edge and competitive advantage.
- Performs all duties as assigned.
Requirements:
- 10 – 15 yrs. experience in Health Care; 10 -12 yrs. Operations experience. 10 years in Leadership positions.
- Experience working in a large highly matrixed organization, with proven ability to develop internal enterprise relations.
- Ability to lead teams and direct workflow across several departments and functions.
- Bachelor's Degree
- Knowledge of payment integrity requirements, state and federal claim payment regulations, claims payment methodologies and claim coding rules
- Experience using Facets.
- Ability to conduct contract negotiations.
- Experience with vendor management and oversight to achieve strategic goals
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 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.
