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Provider Network Analyst Senior - REMOTE [MCO & Advanced Excel Expert Required]

Company: AmeriHealth Caritas
Location: Harrisburg
Posted on: January 18, 2023

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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