CORE Senior Manager


CORE Senior Manager

Reports To: 

CAQH CORE Director 

Friday, December 13, 2019

The CAQH CORE Senior Manager leads research efforts on new technology trends, produces new associated operating rules, identifies potential partnership opportunities, and partners with the CAQH CORE team to coordinate work efforts, market strategies and new business options across CAQH CORE.  A successful Senior Manager in this role must possess a unique blend of critical thinking, strategic, and analytical skills; a thorough knowledge of technical electronic transaction standards and technologies as applied in the health care system, a strategic and collaborative mindset, and product implementation experience to translate findings into concrete operating rules – both infrastructure-based and date content-based and other business opportunities.

The position researches industry needs and trends, tracks industry thought leadership; identifies potential partnership goals for future CAQH CORE operating rules; and contributes to establishing growth or impact estimates across CAQH CORE business areas.  A key responsibility of this role is managing the identification and development of potential new operating rules to adapt to changing market needs and technology, other business opportunities and meaningful expansion of existing CAQH CORE business areas. To manage this pipeline development, the Senior Manager drafts strategic plans for rule writing and related opportunities and collaborates on how these efforts complement the other CAQH CORE strategic goals and associated deliverables. CAQH CORE Senior Manager reports to a CAQH CORE Director; the position is full time, exempt.

Specific Responsibilities: 

.Lead day to day activities of CAQH CORE new and revised operating rule and related business development

  • Identify, manage, create, review and present pertinent data analyses and trending from both internal and external sources to produce opportunity analyses.
  • Partner with CAQH CORE Participants, industry experts and team members to establish impact analyses for targeted opportunities, and relational dependencies across other CAQH CORE business areas.
  • Use research and trending findings to create a consolidated pipeline of potential new CAQH CORE operating rules, related products and collaborate with CAQH CORE leadership and team to launch deliverables.
  • Convene and lead Advisory, Subgroups, Workgroups and Task Groups of CAQH CORE Participants related to new operating rule or related business development.

.Grow CAQH CORE relationships with key industry partners

  • Collaborate with CAQH CORE leadership to strengthen and maintain existing CAQH CORE relationships and foster new strategic partnerships.  
  • Articulate our value proposition so that it empowers current and prospective CAQH CORE Participants to galvanize support for our mission and vision within their respective organization.
  • Attend healthcare conferences, workgroups and other meetings with intent to source and reinforce partnership opportunities.
  • Work internally to foster mutually beneficial working relationships with other CAQH initiatives as appropriate.

.Drive future rule writing wor efforts and adoption

  • Evolve existing operating rules through the application of industry trends, adoption of new technologies, and proven ROI to support new operating rules and related products.  
  • 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.
  • Lead new operating rule or related business prioritization based on strategic fit, and financial/market impact consistent with the CAQH CORE mission/vision.

.Ensure consistent and high-quality work products

  • Work with team to prepare materials to support respective internal and external rule writing and related discussions; including but not limited to workplans, whitepapers, analysis documents, industry presentations, etc. 
  • Effectively engage contracted consultants to identify and document potential technical implementation issues and possible solutions in preparation for review.
  • Lead the drafting and product delivery associated with new operating rule packages including roll out, communications, website update, etc.
  • Coordinate with CAQH CORE team members to ensure scheduling and logistical support are operating efficiently.
  • Other duties as assigned. 
Knowledge, skills and abilities: 

Supervisory Responsibility:

  • Manage matrixed resources of 1-3 project staff; including CAQH staff and consultants  


  • Strong understanding of and experience in the business-to-business side of healthcare, including emerging technology and standards; e.g., FHIR, HL7, NCPDP, X12, XML, etc.
  • Knowledge of common application, integration, and authentication technologies used in the healthcare industry, including XML, JSON, SOAP APIs, RESTful web services, OAuth, SAML, GraphQL., and FHIR
  • Extensive background in healthcare billing and payment processes and the revenue cycle from fee for service through value-based payment models.
  • Problem solver with a commitment to creating high quality deliverables under tight deadlines.
  • Ability to set and manage 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 project teams comprised of reporting/project 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.
  •  Six or more years in the healthcare industry, preferably in a health plan, provider, vendor or other health care operational environment or healthcare management consulting with experience in developing, launching and sustaining healthcare industry products/programs.
  •  Substantive experience coordinating multiple initiatives on a national scale.
  • Bachelor’s degree required.
  • Master’s degree preferred.
  • Degrees in business, public health, healthcare administration 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 the "Best Places to Work" by Modern Healthcare for three consecutive years, 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. Our initiatives include:

  • 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.
  • DirectAssure® increases the accuracy of health plan provider directories.
  • VeriFideTM streamlines credentialing by consolidating and standardizing primary source verification.
  • SanctionsTrack® delivers comprehensive, multi-state information on healthcare provider licensure disciplinary actions. 
  • CAQH CORE® maximizes business efficiency and savings by developing and implementing national operating rules.
  • CAQH Index® benchmarks progress and helps optimize operations by tracking industry adoption of electronic administrative transactions.