Business Engagement ManagerLocation: Philadelphia, PAPrimary Job Function: OperationsID: 24455Your career starts now.
Were looking for the next generation of health care leaders.At AmeriHealth Caritas, were 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, wed 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:Under the direction of the Director, Enterprise Operations Solutions, the Business Engagement Manager is responsible for handling the engagement activities to support all current AmeriHealth Caritas health plans and corporate departments.
This position must have and maintain knowledge of the federal and individual states requirements regarding operational functions, i.e.
claim payments, contact center, and enrollment to ensure optimal operational performance for the assigned products and/or plans.
They will intake, assess and monitor issues and inquiries related to EO raised by the health plans or other corporate departments.
This position will collaborate with key functional areas across all lines of business to ensure completion of root cause analysis and rapid remediation deployment for internal/external requests as well as all exculpated issues from other departments/plans.
The Business Engagement Manger is responsible for the following: Maintains working knowledge of plan state contracts with a focus on Enterprise Operations (EO) related activities and the Service Level Agreements (SLAs).
Responsible to facilitate plan affiliate on site visits as well as develop and conduct presentations as needed.
Work with IS and the associated Business Engagement Consultant for intake and processing of plan project requests.
Establishes cross functional work teams to enable real time resolution of issues.
Issues may include but are not limited to all EO functions (claims, call center, enrollment, etc.).
Serves as a single point of contact for affiliate plans and other corporate departments regarding any issues or requests related to Enterprise Service Operations.
Responsible for the primary interface between the plan and the corporate office to manage all relationships, issues, escalations, projects and inquiries.
Manages the day to day contacts and requests of health plans to ensure the health plans needs are met.
Track, monitor and drive resolutions to issues that impact achievement of key metrics per contractual requirements.
Takes on critical problem solving tasks.
Engages senior leadership as appropriate.
Builds trust and establishes customer relationships focused on open communication.
Key customers include plans, IS leaders and corporate PMO.
Acts as a recognized change agent for the enterprise by influencing and establishing appropriate methods and opportunities to positively address the pace of change.
Responsible for tracking issue resolution against established timeline and alerts responsible department of upcoming due dates to ensure adherence to department standards.
Escalates issues appropriately.
Develops and facilitates project plans, track work performed, work pending and open issues for team comprised of staff and clients.
Lead plan operational meetings, first alert meetings, key provider meetings, meetings with EO departments and ad hoc meetings as required.Education/ Experience: Minimum of 3 years of experience in healthcare, managed care, or insurance industry environment required.
Minimum of 5 years Operations experience with Account/Relationship Management responsibilities.
Bachelors Degree or Equivalent work experience required.
Proven ability to collaborate and execute actionable business strategies.
Ability to influence others and move toward a common vision or goal.
Problem solving and root cause identification skills.
Demonstrated ability to build effective relationships across all levels of leadership.
Excellent verbal communication, presentation and listening skills.
Track record of providing excellent customer service.
Previous claims experience and knowledge of claims operations required.
Prior experience analyzing and defining solutions to complex business and technical issues.
Billing and coding experience/knowledge is a plus Prior experience in managing multiple, large, cross-functional teams and projects, with an eye towards identifying and implementing opportunities to improve business processes.
Prior experience in environments with large, complex, real-time transaction volumes desired.
Maintaining a working knowledge of all EO Functions.
Ability to teach/train others.
Communication skills both oral and written.EOE Minorities/Females/Protected Veterans/Disabled