What are the responsibilities and job description for the Provider Network Operations Data Analyst - Hybrid in DC position at AmeriHealth Caritas?
Responsibilities
The Provider Network Data Operations Analyst is responsible for configuration updates, resolution of claims inquiries, and all other system changes needed to facilitate timely and accurate payment of claims for par and non-par providers in our network. The Provider Network Operations Data Analyst ensures that each provider’s status with the health plan is represented correctly in all plan operating systems; support all projects with the Operations team; and assists with resolution of provider issues.
- Responsible for data intake process including knowledge of relevant systems required to complete job functions.
- Responsible for research and analysis related to contract updates, provider network or claim issues.
- Responsible for reviewing assigned request and ensuring all requirements are met prior to processing.
- Documenting and tracking requests and monitoring processing turnaround time.
- Effectively and professionally communicating to all parties concerned the pertinent information required to execute quality services.
- Responsible for escalating requests contrary to established business processes or contract language for resolution.
- Demonstrating a functional knowledge of provider data and managed care provider reimbursement methodologies.
- Knowledge of Managed Care concepts
- Ability to work independently.
- Supports the investigation of claims issues, to include troubleshooting, edit review, and submission for recycling / reprocessing as appropriate.
- Identifies and reports compliance issues in accordance with Plan policy and procedure.
- Demonstrates a functionally working knowledge of Facets, including the provider database and routinely relays information about additions, deletions, or corrections to Provider Enrollment Services.
- Works with all departments to develop and execute strategies for optimally managing medical costs.
- Administrative responsibilities : Performs other duties and projects as assigned.Adheres to Plan policies and procedures.Attends required training sessions on an annual basis.
Education / Experience :
Diversity, Equity, and Inclusion
At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
Generous paid time off and paid volunteer time off.
Employer-matched 401(k) and additional non-elective contributions, starting on day one.
Medical, dental, and vision plans — with coverage starting on day one.
Employee assistance programs, fitness reimbursements, nutrition counseling, and more.
Employer-paid life insurance, with opportunities to purchase additional coverage.
Employer-paid short-term disability coverage and long-term disability coverage.
Tuition assistance, including reduced tuition at certain schools.
Financial assistance with adoption, including paid time off.
Flexible spending and health savings accounts to pay for qualified expenses.
Discount programs on entertainment, travel, and more.
