CAQH CORE Manager

WHAT YOU GET:

CAQH recognizes that its most important asset is its growing team of smart, creative, collaborative, forward-thinking and passionate professionals – and that a comprehensive employee benefits package is an important factor for them in choosing where to work. CAQH offers competitive compensation along with an extensive benefits package for all full-time employees, including medical, dental and vision coverage, tuition assistance and a 401k. We offer full-time remote work to all staff from any location and maintain a physical office (with many amenities) in downtown Washington, D.C. 

Who we are:

Named one of the "Best Places to Work" by Modern Healthcare for five consecutive years, CAQH has helped nearly 1,000 health plans, 1.6 million providers, government entities and vendors connect, exchange information and operate more efficiently. CAQH technology-enabled solutions and its Committee on Operating Rules for Information Exchange (CORE) bring the healthcare industry together to make sharing business information more automated, predictable and consistent. CAQH Explorations researches opportunities to reduce the burden of manual processes in healthcare administration.

Position

CAQH CORE Manager

Department
CAQH CORE
Reports To

Director, CAQH CORE

The CAQH CORE Manager manages the day-to-day activities of CAQH CORE operating rule development, research, maintenance and implementation. This includes facilitating industry work groups composed of representatives from participating CAQH CORE organizations including – health plans, providers, clearinghouses, software vendors, and industry associations. A successful CORE Manager must possess a unique blend of research and facilitation skills; a big-picture vision, and the drive to make that a reality.

The CAQH CORE Manager leads the development of CAQH CORE work group milestone planning and drafting of CAQH CORE surveys, analysis documents and other deliverables. The position requires knowledge of relevant industry trends, strong written and verbal communication skills, and an analytical mindset. The CAQH CORE Manager reports to the CAQH CORE Director. This is a full-time, exempt, remote position.

Specific Responsibilities
  • Lead day to day activities of CAQH CORE work groups.
    • Manage, create and review group meeting materials such as project plans, agendas, meeting summaries, research summaries and draft rules.
    • Prepare work group Chairs for calls/meetings which include 20-60 individuals from CAQH CORE Participating Organizations by reviewing draft meeting documents with them and updating documents accordingly. Support Chairs during calls/meetings to achieve the expected outcomes including facilitation of key discussions.
    • Maintain a detailed understanding of work group goals and clearly communicate recommendations for improvement and coordination to the CAQH CORE Senior Managers and Directors.
  • Grow CAQH CORE relationships with key industry partners.
    • Help strengthen and maintain existing CAQH relationships and foster new ones by ensuring all CAQH CORE Participants have a voice in the work group discussions.
    • Work with the CAQH CORE Associates to ensure proper communications occur with CAQH CORE Participants who have questions regarding timelines, technical barriers, processes, etc. Escalate significant issues to the CAQH CORE Directors, as appropriate, and develop recommendations for project enhancements based on understanding of evolving CAQH CORE Participant needs.
    • Assist CAQH CORE Directors with management of the CAQH CORE Board through development of meeting materials, conducting research on key topics and outreach.
  • Drive future work efforts and adoption of operating rules.
    • Develops measurement and ROI-tracking efforts that help the CAQH CORE Participants and the market at-large coalesce around new CAQH CORE operating rules and related opportunities including those that may be considered for federal mandate, given CAQH CORE’s role as the designated HHS operating rule author.
    • Drive industry adoption of operating rules through management of the development of implementation tools, FAQs, conference and webinar presentations, attendance at industry events, etc.
    • Maintains strong understanding of potential opportunity areas for CAQH CORE including value-based payments, the healthcare revenue cycle and the convergence of clinical and administrative data.
  • Ensure consistent and high-quality work products.
    • As requested, effectively manage CAQH contracted consultants (within allocated budget) who assist with the work groups. Collaborate with the consultants to identify and document potential technical issues and possible solutions in preparation for review by work group leadership. 
    • Coordinate with CAQH CORE Associates to ensure scheduling and logistical support are operating efficiently and are in sync with all other aspects of CAQH CORE. Ensure all work group participants and consultants are given sufficient time and notice to prepare for all scheduled calls and meetings.
    • Performs other duties as assigned or as necessary.
Knowledge, skills and abilities
  • Strong understanding of and experience implementing emerging payment models.
  • Experience in healthcare billing and payment processes and the revenue cycle.
  • Strong ability to facilitate multi-stakeholder discussions on strategic and technical issues to consensus and move initiatives forward.
  • Problem solver with a commitment to creating high quality deliverables under tight deadlines.
  • Ability to set and manage team priorities and drive collaborative agendas.
  • Excellent writing and editing skills. Ability to write about complex issues clearly and concisely and strong documentation skills.
  • Proven ability to motivate in a team-oriented, time-pressured environment.
  • Ability to plan, organize and effectively present concepts.
  • Skilled in organizing the evaluation of information from a variety of sources to create fact-based recommendations.
  • Proactive nature with desire to influence through action.
  • Willingness and ability to manage ad hoc project teams comprised of staff, volunteers and consultants often representing divergent views.
  • Prior and in-depth knowledge of HIPAA transaction standards and/or HL7 FHIR preferred.
  • Ability to simultaneously manage multiple assignments and create comprehensive work plans.
Experience
  • 6-10 years in the healthcare industry.
  • Five to eight years of coordinating multiple projects or groups.
  • Prior knowledge of value-based payment models preferred.
Education
  • Bachelor’s degree required.
  • Master’s degrees preferred.
  • Degrees in healthcare administration, public health, or health technology disciplines preferred.
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Employment Type
FULL_TIME
Hiring Organization
CAQH