Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is seeking a Senior Provider Network Analyst to support provider network operations. The role focuses on ensuring accurate provider data, maintaining compliance with contract requirements, and driving operational efficiency through data analysis and reporting.
Responsibilities
- Analyze provider data to identify trends, discrepancies, and process improvement opportunities
- Extract, validate, and maintain accurate provider data to support new implementations and ongoing operations
- Ensure compliance with provider contracts, state requirements, and internal policies
- Interpret provider contracts, state policies, and business requirements, and translate them into system configuration
- Maintain and update benefit plans, provider contracts, fee schedules, and system tables
- Perform quantitative and qualitative analysis to evaluate financial and operational impacts
- Conduct data mining and impact analysis to support configuration decisions and issue resolution
- Create, maintain, and enhance reports to support business decision-making
- Utilize contract maintenance systems to build templates and manage documentation (e.g., contracts, credentialing forms)
- Support configuration activities, including testing, validation, and implementation of system changes
- Research and resolve claims, encounter, and provider data issues, including pending claims
- Assist with root cause analysis and provide recommendations for issue resolution
- Collaborate with cross-functional teams to address production issues and support system enhancements
- Manage multiple priorities and adapt to changing workload demands
Skills
- Bachelor's degree in business, healthcare, or a related field, or equivalent experience
- 1 to 3 years of healthcare or managed care experience
- 3 to 5 years of analytical experience in a healthcare environment
- Strong analytical and problem-solving skills, with the ability to interpret complex data and make actionable recommendations
- Ability to perform data validation, impact analysis, and root cause analysis
- Strong attention to detail with a focus on accuracy and data integrity
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment
- Effective organizational and time management skills
- Strong written and verbal communication skills, including the ability to present findings clearly
- Ability to collaborate across teams and build effective working relationships
- Ability to quickly learn new systems, tools, and processes
- Working knowledge of healthcare coding sets, claims processes, and regulatory requirements
- Experience with provider data, claims processing, or network operations
- Knowledge of Facets or similar configuration platforms
- Experience with SQL, MS Access, or other data/query tools
- Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint), with advanced Excel skills strongly preferred and Power BI
Benefits
- This role is fully remote, and the associate must be able to work Eastern Standard Time (EST) hours.
- Candidates must have access to reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload).
- Associates in locations where required may be eligible for internet reimbursement based on applicable regulations.
Company Overview