Senior Manager - Provider Services

Be part of something bigger-make an impact in a growing organization! CareCentrix is committed to making the home the center of patient care.

The Senior Manager is accountable for the ensuring accurate and timely claims payment, consistent cash flow, resolution of operational issues identified, and alignment with all internal CCX functional areas that impact the provider experience. The Senior manager is responsible for the management and oversight of Provider AR and improvement of systematic or manual processes. The position will identify and assist in prioritization of scalable, provider-based plans that improves operational related activities. Provides appropriate direction to provider community on CCX related processes through effective identification and resolution of provider outstanding open accounts.

In this Job, you will:

• Lead the Provider Service delivery team focused on addressing provider related issues, business and system defects with a focus to resolve large volume/dollar of outstanding claims to bring account receivable work efforts to resolution.
• Identify key trends, system and operational issues impacting specific provider or global issues impacting claim adjudication
• Provide leadership and direction ensuring the organization's and Revenue Cycle Management's strategic plan is translated into tactical goals and objectives that meet/exceed expectations.
• Manage provider operational/claims/Accounts Receivable related issues including identification, root cause analysis, analytics, documentation, and solution development through a structured, data-driven disciplined process.
• Develop and implement Strategic and Tactical Plans to reduce Provider Denials and the rejection rate.
• Identify root cause of Provider denials, such as System, Provider, Plan, or Processor, and drives remediation and resubmission of claims where possible.
• Work with Revenue Cycle Management Leadership to plan and execute the cross-functional implementation strategies.
• Act as a claims liaison to our providers to ensure clear and precise understanding, documenting and status tracking of provider operational issues.
• Provide leadership necessary to maintain a motivated, productive team through open communication and delegation of responsibilities and authority.
• Create a work environment where productivity can be sustained and accomplished and where innovation and personal growth are encouraged and realized.
• Participate in and contribute to performance improvement activities.
• Participate in implementing / maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates.
• Participate in special projects and performs other duties as assigned.

Fee Schedule Governance

• Partner with CareCentrix Business Technology team members during the requirements (CRD, Business Requirements Definition (BRD) and technology planning) for the implementation of system changes
• Lead the enterprise-wide Fee Schedule Governance (FSG) program to ensure complete and accurate load of provider demographics and rate details within the provider core systems that interface with the claims platforms. Ensure all service level agreements (SLAs), quality review and collaboration between Network Management, Credentialing, Fee Schedule Governance and Business Technology (Data Management) meet and exceed expectations.
• Develop plans to continue the collaboration between Network Management, Credentialing, Feed Schedule Governance and Business Technology to drive business and technology improvements to ensure accurate data loads into production
• Production Leadership - Oversight of quarterly and annual HCPCS code updates, participates on various committees directly related to product, contracting and credentialing aligned with fee schedule (plan and provider) maintenance
• Provide executive level leadership updates (Operating Committee, CMI, etc.) to provide updates on projects, production support or Fee Schedule Governance performance and risks

You should get in touch if you have:

• Bachelor's Degree in a Business disciplined degree preferred.
• 5-7 years' experience in a Supervisory or Management role leading a cross functional team of associates.
• Demonstrated work experience in execution of strategic planning, program/project development, and implementation
• Excellent organizational and analytical skills required.
• Knowledge of Claim Processing, Blue Card, provider portal and HIPAA 5010 standards preferred.
• Strong written and verbal communication skills with experience interacting with Providers and Billing Agencies.
• Advanced proficiency in Microsoft Excel, PowerPoint, Visio and Access
• Demonstrated ability to lead projects, demonstrate outstanding interpersonal skills and work well with people and foster and facilitate collaboration with internal stakeholders
• Ability to think strategically and translate into deliverable results.

What we offer:

• Competive Salary $80k - $85k plus Corporate Bonus
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
• Advancement opportunities, professional skills training, and tuition Reimbursement
• Great culture with a sense of community.

CareCentrix maintains a drug-free workplace.

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

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