Provider Network Analyst Senior - REMOTE [MCO & Advanced Excel Expert Required]
Company: AmeriHealth Caritas
Location: Harrisburg
Posted on: January 18, 2023
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Job Description:
**Provider Network Analyst Senior - REMOTE [MCO & Advanced Excel
Expert Required]**Location: Harrisburg, PAPrimary Job Function:
Medical ManagementID**: 27164Your career starts now. We're looking
for the next generation of health care leaders.At AmeriHealth
Caritas, we're passionate about helping people get care, stay well
and build healthy communities. As one of the nation's leaders in
health care solutions, we offer our associates the opportunity to
impact the lives of millions of people through our national
footprint of products, services and award-winning programs.
AmeriHealth Caritas is seeking talented, passionate individuals to
join our team. Together we can build healthier communities. If you
want to make a difference, we'd like to hear from you.Headquartered
in Philadelphia, AmeriHealth Caritas is a mission-driven
organization with more than 30 years of experience. We deliver
comprehensive, outcomes-driven care to those who need it most. We
offer integrated managed care products, pharmaceutical benefit
management and specialty pharmacy services, behavioral health
services, and other administrative services. Discover more about us
at www.amerihealthcaritas.com .**Responsibilities:**The Provider
Network Analyst Senior is responsible for research and analysis
related to provider network issues. The incumbent will support new
business provider recruitment and contracting and/or conduct
research and analysis related to provider claims issues.Key
responsibilities:+ Identifies systematic and procedural issues
resulting in processing reports and initiating actions to produce
reports.+ Extract, manipulate and evaluate accuracy of provider
data for new implementations.+ Responsible for ensuring plan remain
in compliance with provider contracts.+ Gathers complex statistical
data analysis to identify financial and non-financial impacts,
process and system improvements.+ Use provider contract maintenance
software to create provider contract templates and create files
associated with contract templates and other credentialing forms.+
Assist and coordinates configuration and testing to generate new
reports as required.Configuration Management Responsibilities
include, but are not limited to:+ Analyzes and interpret data to
determine appropriate configuration changes using in depth
expertise in data analysis and data mining.+ State
benefits/policies, provider contracts, business requirements and
converting these terms to configuration parameters.+ Accurately
interprets, updates and maintains benefit plans, provider
contracts, fee schedules and various system tables through for the
purpose of triaging production issues and developing business
requirements for new configuration.+ Demonstrates previous
experience and knowledge to research and resolve claim/encounter
issues, pended claims and update system(s) as necessary.+ Works
with fluctuating volumes of work and can prioritize work to meet
deadlines and needs of user community.**Education/Experience:**+
Bachelor's Degree or equivalent analytical experience+ 5+ years in
managed health care provider relations with demonstrated skill in
utilization of commercial software applications supporting network
adequacy and directory reporting+ Comfortable leading and training
as this role is often training the coordinators on processes and
changes.+ Communication skills are needed for instruction necessary
to direct Intake coordinators in meetings is required in every
market. Communication is needed to be able to break information
down and explain it to other departments. Its also needed to follow
up and provider status updates.+ Strong research and analytical
skills.+ Problem resolver, this role requires an analyst to present
ideas, find the best way to extract data when a challenge is
presented or figure out the best way to capture or track data.+
Flexibility, being able to pivot/transition easily to the a
priority project is key.+ Willing to work as a team. Teamwork is
very important as our analysts are often paired together on
different projects to meet deadlines.+ EXP experience preferred.+
Access database experience preferred.+ Advanced EXCEL experience
necessary.EOE Minorities/Females/Protected Veterans/Disabled
Keywords: AmeriHealth Caritas, Harrisburg , Provider Network Analyst Senior - REMOTE [MCO & Advanced Excel Expert Required], Professions , Harrisburg, Pennsylvania
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