Provider Network Operations Data Analyst (Hybrid New Hampshire)

Responsibilities

The Provider Network Data Analyst is responsible for building and maintaining positive working relationships between AmeriHealth Caritas New Hampshire Health plan and its contracted and non-contracted providers for all products, Medicaid, Medicare, and Exchange. Provider Network Data Analyst ensures that providers’ status with the health plan is represented correctly in all Plan operating systems, functions as a pro-active practice account leader, and coordinates resolution of provider issues.

Responsible for monitoring and managing provider networks by assuring appropriate access to services throughout the Plan’s territory in keeping with state contract mandates.

Responsible for provider data management

Maintaining a provider data change database, documenting and tracking requests, and monitoring processing turnaround time.

Responsible for data intake process, including knowledge of relevant systems required to complete job functions.

Responsible for reviewing the data intake forms for accuracy and completeness.

Effectively and professionally communicate the pertinent information required to execute quality services to all parties concerned.

Responsible for escalating requests contrary to established business processes or contract language for resolution.

Demonstrates a functional knowledge of provider data and managed care provider reimbursement methodologies.

Knowledge of Managed Care concepts

Demonstrates ability to work independently.

Identifies, contacts, and actively solicits qualified providers to participate in the Plan at new and existing service areas, assuring the financial integrity of the Plan is maintained and Contract Management requirements are adhered to, including language, terms, and reimbursement requirements.

Responsible for the accuracy and timely management of the provider contracts

This position supports the credentialing and re-credentialing process and investigating member complaints.

This position completes requests for initial site visits within the time specified by Department standards. This may include requests to review an existing participating physician’s new office location.

Submits completed site visit forms to the Credentialing Department within time period specified by Department standards.

Obtains documentation required for credentialing for credentialing or re-credentialing of providers as requested.

Completes requests for investigation of member complaints within time period specified by Department standards.

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 the Provider Maintenance Department.

Works with all departments to develop and execute strategies for optimally managing medical costs.

Administrative responsibilities :

Adheres to Plan policies and procedures.

Attends required training sessions on an annual basis.

Education / Experience :

Bachelor’s Degree or equivalent work experience.

Experience with utilizing Excel and Microsoft tools.

1 to 2 years of Medicaid experience preferred; 1 year in a Provider Services position.

3 years in the managed care / health insurance industry.

Other Skills :

Previous experience working with healthcare providers. Previous provider relations experience preferred.

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.