Job Brief
The Provider Network Analyst Sr. will be responsible for being the go to person for research and analyst of provider issues. Experience with claims and billing required. Knowledge of Medicaid market preferred.
Your 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
Responsibilities
Responsible for research and analysis related to provider network issues. Supports new business provider recruitment and contracting or responsible for research and analysis related to provider claims issues. Identifies systematic and procedural issues resulting in processing reports and initiating actions to produce reports. Extracts manipulates, and evaluates accuracy of provider data for new implementations or responsible for ensuring plan stays in compliance with provider contracts.
Gathers complex statistical data analysis to identify financial and non-financial impacts and process and system improvements. Uses provider contract maintenance software to create provider contract templates and creates files associating contract templates and other credentialing forms. Assists with and coordinates configurations and testing and generates new reports as required.
Education/ Experience
- Bachelor’s Degree preferred or an equivalent education and experience.
- Facets configuration knowledge preferred
- Building queries using SQL, MS Access, or other technical analysis tools.
- 1 to 2 years managed care or related experience.
- Advanced experience with sophisticated databases with 3 to 5 years analytical experience in the Healthcare industry.
- Superior analytical skills.
- Proficiency with Microsoft Office Suite (Word, Excel, Power Point).
- Full competence in report preparation, layout and design.
- Ability to plan, organize and handle multiple tasks.
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