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

CORE Manager

Department
CAQH CORE
Reports To

Vice President, CAQH CORE

The CAQH CORE Manager leads the day-to-day activities of CAQH CORE operating rule development, research, maintenance, and implementation. This includes facilitating industry work groups composed of representatives leading healthcare 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 manages the development of CAQH CORE work group milestone planning, 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 Vice President. This is a full-time, exempt, remote position.

Specific Responsibilities
  • Lead day to day activities of CAQH CORE work groups.
    • Serve as lead project manager for operating rule development efforts responsible for managing internal resources, work plan, and key project milestones and goals.
    • Lead development of work group meeting materials such as project plans, agendas, meeting summaries, research summaries, and draft rules.
    • Prepare work group Chairs to lead calls/meetings which typically include 25-50 individuals from CAQH CORE Participating Organizations to achieve meeting goals including facilitation of discussions.
    • Maintain a detailed understanding of work group goals and clearly communicate recommendations for improvement to the CAQH CORE Vice President.
  • Grow CAQH CORE relationships with key industry partners.
    • Help strengthen existing CAQH CORE relationships and foster new ones by ensuring all organizations 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 Vice President and develop recommendations for project enhancements based on understanding of evolving industry needs.
    • Assist CAQH CORE Vice President with management of the CAQH CORE Board efforts through development of meeting materials, conducting research on key topics, and outreach.
    • Support CAQH CORE in its role as the National Operating Rule Authoring Entity, as designated by the Secretary of HHS, by reviewing regulation, drafting comments, and preparing for meetings with federal partners.
  • Drive future work efforts and adoption of operating rules.
    • Develop measurement and ROI-tracking efforts that demonstrate value of CAQH CORE operating rules and related opportunities.  
    • Drive industry adoption of operating rules through managing development of implementation tools, FAQs, conference and webinar presentations, attendance at industry events, etc.
    • Maintain 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 and technical content. 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.
    • Performs other duties as assigned or as necessary.
Knowledge, skills and abilities
  • 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.
  • Experience in healthcare billing and payment processes and revenue cycle.
  • 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.
  • 1-2 direct reports; manage matrixed resources of 1-3 project staff including CAQH staff and consultants.
Experience
  • 6-10 years in the healthcare industry.
  • Five to eight years of coordinating multiple projects or groups.
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