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At AmeriHealth Caritas, we’re 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’d 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.
The position of Manager Vendor/Client Management is accountable for supporting and maintaining relationships with AmeriHealth Caritas Family of Companies (ACFC) lines of business (LOB), and vendors supporting the Payment Integrity organizations commitments to offsetting growing trends in Fraud, Waste and Abuse, Audit Recovery Operations (data mining), Coordination of Benefits, Subrogation and all other prospective and retrospective operations established to drive savings for ACFCs. The Vendor/Client manager role is responsible for supporting the development, implementation and management of specific vendor management relationships in order to help achieve best value, manage costs, and manage risks related to payment integrity.
- Participation in monthly leadership and client meetings for Payment Integrity. This will include:
- Reporting on Payment Integrity Savings by plan
- Develop and manage an LOB Issue repository/process and coordinate closure across the Payment Integrity organizations – Communicate status monthly
- Lead and/or participate in the Edit approval process for deployment of Edits for payment integrity across Medicaid, Medicare, PBM and Behavioral.
- Orchestrate and lead the approval process assertively.
- Provide regular communication and reporting cadence to the members of the Edit approval process.
- Communicate status cross-functionally
- Act as a liaison between the plans and the vendors to resolve issues or concerns
- Support Vendor Management strategy for Payment Integrity
- Monitor vendor oversight criteria/metrics for managing vendors to achieve payment integrity results for ACFC.
- Monitor internal and external reports
- Participate in all negotiations
- Lead or be part of Vendor Audits on behalf of Payment Integrity
- Gain Knowledge in understanding Oversight roles as it relates to CMS regulations for oversight.
- Monitor Overpayment Project Inventory
- Act as a liaison between Vendor and Plan for issue resolution
- Bachelor’s Degree preferred with equivalent work experience.
- Prior vendor and/or customer relationship management required.
- Strong financial and project based acumen required.
- 3-5 years Financial and project management.