CORE Manager


CORE Manager

Reports To: 

CORE Director

Tuesday, December 18, 2018

The CORE Manager manages the day-to-day activities of CAQH CORE operating rule development, research, maintenance and implementation. This includes facilitating industry work groups which include individuals from participating CAQH CORE organizations representing all stakeholder communities – health plans, providers, clearinghouses and software vendors. 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.

CAQH CORE research and rule development will focus on opportunities for streamlining value-base payment models across the industry in addition to opportunities within traditional, fee-for-service. In conjunction with the CORE Director, the Project Manager leads the drafting of CAQH CORE group projects, work plans and deliverables, all of which are used and reviewed by the CAQH CORE work groups. The CORE Manager reports to the CORE Director, in the CAQH CORE organization; the position is full time, exempt. 

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 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 CORE 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 CORE Directors, as appropriate, and develop recommendations for project enhancements based on understanding of evolving CAQH CORE Participant needs.
    • Assist 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.
    • Develop criteria and research that helps 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.
    • Monitor and respond to federal and state efforts related to administrative simplification including preparation of testimony for federal advisory committees, drafting of comment letters, etc.
  • 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 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.
  • Extensive background 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 preferred.
  • Ability to simultaneously manage multiple assignments and create comprehensive work plans.
  • Excellent interpersonal communication and conflict resolution skills.
  • Attention to detail is a critical requirement.

Supervisory Responsibility:

  • 1-2 FTEs.
  • Consultants, as relevant and appropriate.
  • Six to ten years in the healthcare industry, preferably in healthcare management consulting.
  • Five to eight years of coordinating multiple projects or groups.
  • Experience developing and/or implementing value-based payment models preferred.
  • Bachelor’s and Master’s degrees preferred.
  • Degrees in healthcare administration, public health, or health technology disciplines preferred.
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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. Our location in downtown Washington, DC is metro-accessible, has an onsite fitness center and is centrally located to allow our team to take advantage of professional networking opportunities, cultural offerings and a thriving social scene.

Who we are:

Named one of Modern Healthcare’s Best Places to Work in 2017 and 2016, CAQH, a non-profit alliance, is the leader in creating shared initiatives to streamline the business of healthcare. Through collaboration and innovation, CAQH accelerates the transformation of business processes, delivering value to providers, patients and health plans.

  • COB Smart® quickly and accurately directs coordination of benefits processes.
  • EnrollHub® reduces costly paper checks with enrollment for electronic payments and electronic remittance advice.
  • CAQH ProView® eases the burden of provider data collection, maintenance and distribution.
  • SanctionsTrack® delivers comprehensive, multi-state information on healthcare provider licensure disciplinary actions. 
  • CAQH CORE® maximizes business efficiency and savings by developing and implementing federally mandated operating rules.
  • CAQH Index® benchmarks progress and helps optimize operations by tracking industry adoption of electronic administrative transactions.