Highlights
Role Overview: The Provider Network Operations Supervisor supports the daily operations of the Provider Network Operations team by overseeing staff performance, ensuring operational efficiency, and maintaining compliance with internal policies and contractual requirements. + Ensure operational processes align with internal policies, contractual obligations, and service level agreements (SLAs).
Numbers & Facts
| Location | Southfield, MI (Remote) |
| Industry | Healthcare Services |
| Company Size | 5,000 to 9,999 employees |
| Year Founded | 1985 |
| Website | http://www.amerihealthcaritas.com |
Description
Role Overview: The Provider Network Operations Supervisor supports the daily operations of the Provider Network Operations team by overseeing staff performance, ensuring operational efficiency, and maintaining compliance with internal policies and contractual requirements.
Work Arrangement:
+ Remote - This position is fully remote; the candidate must be located in Michigan (MI) and attend monthly meeting as needed in Southfield, MI.
+ Requires reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload)
+ Internet reimbursement may be available where required by law or contract
Responsibilities:
+ Supervise, coach, and monitor staff performance to ensure quality and timely completion of work
+ Support the Manager in implementing departmental initiatives and process improvements
+ Ensure operational processes align with internal policies, contractual obligations, and service level agreements (SLAs)
+ Oversee and support the resolution of provider inquiries and complaints, ensuring timely and effective outcomes
+ Monitor provider data maintenance and/or claims-related activities, providing feedback and recommendations for improvement
+ Research and resolve complex claims issues and operational discrepancies
+ Identify operational challenges and recommend solutions to improve performance and compliance
+ Participate in special projects and perform additional duties as assigned
Education & Experience:
+ Associate degree required or equivalent combination of education and relevant work experience
+ 1 to 3 years of supervisory or leadership experience preferred
+ Experience in managed care or a healthcare environment preferred
+ Knowledge of claims processing, coding, payment, and/or provider data operations strongly preferred
+ Familiarity with Medicaid reimbursement methodologies preferred
Skills & Abilities:
+ Strong leadership and team development capabilities
+ Knowledge of healthcare operations, particularly claims and provider data
+ Analytical and problem-solving skills with attention to detail
+ Ability to manage multiple priorities in a fast-paced environment
+ Strong communication and interpersonal skills
+ Ability to identify process improvement opportunities and drive change
As a company, we support internal diversity through:
Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.
Work Arrangement:
+ Remote - This position is fully remote; the candidate must be located in Michigan (MI) and attend monthly meeting as needed in Southfield, MI.
+ Requires reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload)
+ Internet reimbursement may be available where required by law or contract
Responsibilities:
+ Supervise, coach, and monitor staff performance to ensure quality and timely completion of work
+ Support the Manager in implementing departmental initiatives and process improvements
+ Ensure operational processes align with internal policies, contractual obligations, and service level agreements (SLAs)
+ Oversee and support the resolution of provider inquiries and complaints, ensuring timely and effective outcomes
+ Monitor provider data maintenance and/or claims-related activities, providing feedback and recommendations for improvement
+ Research and resolve complex claims issues and operational discrepancies
+ Identify operational challenges and recommend solutions to improve performance and compliance
+ Participate in special projects and perform additional duties as assigned
Education & Experience:
+ Associate degree required or equivalent combination of education and relevant work experience
+ 1 to 3 years of supervisory or leadership experience preferred
+ Experience in managed care or a healthcare environment preferred
+ Knowledge of claims processing, coding, payment, and/or provider data operations strongly preferred
+ Familiarity with Medicaid reimbursement methodologies preferred
Skills & Abilities:
+ Strong leadership and team development capabilities
+ Knowledge of healthcare operations, particularly claims and provider data
+ Analytical and problem-solving skills with attention to detail
+ Ability to manage multiple priorities in a fast-paced environment
+ Strong communication and interpersonal skills
+ Ability to identify process improvement opportunities and drive change
As a company, we support internal diversity through:
Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.
About Company
Leaders in health care solutions for those most in need
AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.
Our mission, our goal
Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.