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AmeriHealth Caritas · 10 hours ago

Director of Provider Network Operations

Baton Rouge, LA

Full-time

Hybrid

Director/Executive

8+ years exp

AmeriHealth Caritas is seeking a Director of Provider Network Operations responsible for overseeing and managing local operational functions to ensure efficient performance and compliance. This role involves ensuring that plan policies meet regulatory standards and serving as a key representative during Department of Health and Hospitals meetings.

Health CareInformation Technology

H1B Sponsor Likely

Responsibilities

Oversee the full operations of the provider network

Ensure the accuracy and completeness of provider data as the initial entry point into Enterprise systems

Maintain a working and strategic understanding of medical billing principles, including ICD‑9, ICD‑10, CPT codes, and related documentation requirements

Translate contract provisions accurately and in a timely manner into Facets, including analysis and modification of business processes to support efficient contract operations

Lead provider and claims education efforts and maintain provider directory accuracy

Present new ideas aligned with continuous quality improvement (CQI) principles and motivate teams to apply CQI in daily work

Collaborate effectively across all levels of management, building strong relationships and supporting cross-functional problem-solving

Foster team collaboration, share information proactively, and prioritize team goals

Qualification

Managed care experienceProvider reimbursementContracting experienceFacets experienceHIPAA knowledgeNCQA knowledgeQuality improvementLeadership skillsCommunication skillsTeam collaboration

Required

Bachelor's degree required

8 years of progressive business management experience, preferably within healthcare

5 years of management experience in a managed care environment, including leading teams and managing complex projects

3 years of managed care experience in provider reimbursement, contracting, or claims

Strong functional knowledge of the operations department workflows

Ability to make administrative and procedural decisions on sensitive and confidential issues

Skilled in examining and re-engineering operational processes, formulating policy, and implementing new strategies

Strong communication skills, including active listening and effective feedback delivery

Ability to work effectively with diverse constituencies and across all levels of management

Demonstrated leadership in developing, coaching, and motivating team members

Proven ability to collaborate, share information freely, and build on team ideas to solve problems

Commitment to continuous quality improvement and operational excellence

Preferred

1 to 2 years of Medicaid experience preferred

Previous experience developing and delivering presentations

HIPAA, NCQA, and Facets experience preferred

Previous experience managing client-facing relationships is advantageous

Company

AmeriHealth Caritas

Glassdoor3.4

AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.

Founded in 1982

Philadelphia, Pennsylvania, USA

10001+ employees

http://www.amerihealthcaritas.com

H1B Sponsorship

AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (18)

2024 (17)

2023 (12)

2022 (14)

2021 (4)

2020 (11)