What are the responsibilities and job description for the Provider Network Operations Analyst position at AMERINC?
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 healthcare 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 Newtown Square, PA, 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.
Position Overview: The Operations Analyst is responsible for conducting root cause analysis and developing reports, studies, and data models to monitor the accuracy of benefit interpretation, claim payment, provider contract configuration, eligibility processing, and revenue-generating interfaces across various lines of business. This role involves defining and implementing data modeling tools or reports to routinely assess existing operational processes, including benefit interpretation, claim payment accuracy, system interfaces, and integration.
Key Responsibilities:
- Facilitate or perform root cause analysis to identify issues and improve processes.
- Develop reports, studies, and data models related to monitoring operational accuracy.
- Define and implement data modeling tools or reports to assess and improve existing operations.
- Monitor the accuracy of benefit interpretation, claim payment, provider contract configuration, eligibility processing, and revenue-generating interfaces.
- Ensure systems, interfaces, and integration are functioning correctly and efficiently.
Education & Experience:
- High School Diploma or GED required.
- Bachelor’s Degree or equivalent education and experience preferred.
- 3 to 5 years of healthcare claims experience preferred.
- Experience in report writing, data analysis, and data research in managed care operations is preferred.
- Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint); Access is a plus.
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 include 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.
